Provider Demographics
NPI:1629116728
Name:LATTANZE, STACEY ERIN (PA-C)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:ERIN
Last Name:LATTANZE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 MEMORY LN
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-2231
Mailing Address - Country:US
Mailing Address - Phone:717-949-2777
Mailing Address - Fax:
Practice Address - Street 1:2496 STIEGEL PIKE
Practice Address - Street 2:
Practice Address - City:SCHAEFFERSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17088-7021
Practice Address - Country:US
Practice Address - Phone:717-949-2777
Practice Address - Fax:717-949-6925
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002230-L363AM0700X
PAOA003364363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical