Provider Demographics
NPI:1982712816
Name:LASKO, LESLIE-ANN C (PA-C)
Entity Type:Individual
Prefix:
First Name:LESLIE-ANN
Middle Name:C
Last Name:LASKO
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 1:1629 UNION AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:NATRONA HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:15065-2134
Mailing Address - Country:US
Mailing Address - Phone:724-671-1161
Mailing Address - Fax:724-671-1170
Practice Address - Street 1:1629 UNION AVE STE 4
Practice Address - Street 2:
Practice Address - City:NATRONA HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:15065-2134
Practice Address - Country:US
Practice Address - Phone:724-671-1161
Practice Address - Fax:724-671-1170
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052545363A00000X
PAOA002701363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
11692426OtherCAQH
PA103182779Medicaid