Provider Demographics
NPI:1023776838
Name:SAURBAUGH, LACEY MARIE (CRNP)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:MARIE
Last Name:SAURBAUGH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 HAMPSTEAD DRIVE
Mailing Address - Street 2:
Mailing Address - City:STRASBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17602
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1735 ROCKVALE RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-1313
Practice Address - Country:US
Practice Address - Phone:717-413-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP024302207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP024302OtherPA STATE BOARD OF NURSING