Individual
LORI NICOLE BRACKBILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2104 HARRISBURG PIKE STE 200, LANCASTER, PA 17601-2644
(717) 544-3626
(717) 544-3628
Mailing address
2104 HARRISBURG PIKE STE 200, LANCASTER, PA 17601-2644
(717) 544-3626
(717) 544-3628
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
MA055163
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1032013000003
—
PA
01
—
1603241
GATEWAY MEDICARE ASSURED
PA
01
—
2678804
HIGHMARK BLUE SHIELD - FREEDOM BLUE
PA
Enumeration date
11/03/2011
Last updated
09/22/2022
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