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Organization
PENN MEDICINE LGHP GERIATRICS
Active
Organization
PENN MEDICINE LGHP GERIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY BROWN (PROVIDER COORDINATOR)
(717) 544-1921
Entity
Organization
Contact information
Practice address
212 WILLOW LAKES DR., SUITE 101, WILLOW STREET, PA 17584
(717) 464-0286
Mailing address
212 WILLOW VALLEY LAKES DR STE 101, WILLOW STREET, PA 17584-9668
(717) 464-0286
(717) 945-4575
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
—
—
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
08/28/2015
Last updated
09/04/2025
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