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NPI Code Detail

MEDICARE: LAUREN ELIZABETH PACINELLI MAT, LAT, ATC

MEDICARE: LAUREN ELIZABETH PACINELLI MAT, LAT, ATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic TrainerRT005606PA

General Provider Information

NPI Number : 1508396615
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAUREN ELIZABETH PACINELLI MAT, LAT, ATC
Provider Business Mailing Address
First Line : 9185 LAKE PLEASANT RD
Second Line :
City : ERIE
State : PA
Zip : 16509-5749
Country : US
Telephone Number : 814-490-3088
Fax Number :
Provider Business Practice Location Address
First Line : 109 UNIVERSITY SQ
Second Line :
City : ERIE
State : PA
Zip : 16541-0002
Country : US
Telephone Number : 814-871-5300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2017
Last Update Date : 06/13/2017

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Directions to “ LAUREN ELIZABETH PACINELLI MAT, LAT, ATC” Practice Location

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