Individual
LYLELAINE BACALLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
50 ANDREWS COURT, UPPER CHICHESTER, PA 19014
(484) 432-8410
Mailing address
50 ANDREWS CT, UPPER CHICHESTER, PA 19014-3359
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN580508
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A04426880
ALIEN NUMBER
PA
Enumeration date
01/15/2014
Last updated
01/15/2014
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