Individual
ANDREA LYNNE LACKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3000 FAIRWAY DR, ALTOONA, PA 16602-4472
(814) 962-1166
Mailing address
614 N TERRACE DR, ALTOONA, PA 16602-2965
(814) 441-4861
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0110002349
VA
363AS0400X
Surgical Physician Assistant
C0003589
MD
363AS0400X
Surgical Physician Assistant
Primary
MA053507
PA
Other
Enumeration date
03/30/2007
Last updated
05/06/2010
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