Individual
LAURIE FOCACCI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, MPS
Contact information
Practice address
701 N CLAYTON ST, MOB 401, WILMINGTON, DE 19805-3165
(302) 421-4800
(302) 421-4189
Mailing address
655 LAWNTON TER, HOLMES, PA 19043-1021
(484) 494-6349
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
008557-1
NY
363AS0400X
Surgical Physician Assistant
Primary
C5-0000525
DE
363AS0400X
Surgical Physician Assistant
MA052669
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0001001202
—
DE
01
—
2120316000
BLUE SHIELD PC
—
01
—
2935112
AETNA
—
Enumeration date
03/22/2007
Last updated
09/10/2015
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