Individual
LACIE LYNANN SANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
52 RED HILL CT, NEWPORT, PA 17074-8706
(717) 567-3151
(717) 567-7571
Mailing address
7 DOCK HILL RD, MIDDLEBURG, PA 17842-8910
(570) 837-2123
(570) 837-2185
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA056200
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1031860430001
—
PA
Enumeration date
05/28/2013
Last updated
08/09/2024
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