Provider Demographics
NPI:1922889328
Name:RINALDI, LACEY ELIZABETH (PA-C)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:ELIZABETH
Last Name:RINALDI
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 1:2310 MOTICHKA RD
Mailing Address - Street 2:
Mailing Address - City:MADISON TWP
Mailing Address - State:PA
Mailing Address - Zip Code:18444-7056
Mailing Address - Country:US
Mailing Address - Phone:570-815-1906
Mailing Address - Fax:
Practice Address - Street 1:2310 MOTICHKA RD
Practice Address - Street 2:
Practice Address - City:MADISON TWP
Practice Address - State:PA
Practice Address - Zip Code:18444-7056
Practice Address - Country:US
Practice Address - Phone:570-815-1906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA064817363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical