Provider Demographics
NPI:1700872512
Name:LAKOSE, LEIGH ANN (CRNA)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:ANN
Last Name:LAKOSE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 S CEDAR CREST BLVD
Mailing Address - Street 2:SUITE #301
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6258
Mailing Address - Country:US
Mailing Address - Phone:610-402-9099
Mailing Address - Fax:610-402-9029
Practice Address - Street 1:17TH & CHEW STREET
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102
Practice Address - Country:US
Practice Address - Phone:610-402-9099
Practice Address - Fax:610-402-9029
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN540112163W00000X
PA073188367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1675591OtherFIRST PRIORITY
PA91168OtherGEISINGER
PA1027903300001Medicaid
PA11803096OtherCAQH
PA50044079OtherCAPITAL ADVANTAGE
PA1547450OtherGATEWAY
PA9600447OtherAETNA
PA1675591OtherHIGHMARK
PA2350214000OtherINDEP. BLUE CROSS
PA2001552OtherKHP CENTRAL
PA9600447OtherAETNA
PA1027903300001Medicaid
PA087595QCYMedicare PIN