Provider Demographics
NPI:1689252587
Name:EHRENFEUCHTER, LACEY M
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:M
Last Name:EHRENFEUCHTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 N PROGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-1014
Mailing Address - Country:US
Mailing Address - Phone:717-657-1149
Mailing Address - Fax:
Practice Address - Street 1:550 N PROGRESS AVE # 8979
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-1014
Practice Address - Country:US
Practice Address - Phone:717-657-1149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP023303363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily