MEDICARE: STACEY ERIN LATTANZE PA-C

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
1	363AM0700X	Medical Physician Assistant	MA002230-L	PA
2	363AS0400X	Surgical Physician Assistant	OA003364	PA

General Provider Information

NPI Number	:	1629116728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY ERIN LATTANZE PA-C

Provider Business Mailing Address
First Line	:	1701 CORNWALL RD
Second Line	:	STE 201
City	:	LEBANON
State	:	PA
Zip	:	17042-7480
Country	:	US
Telephone Number	:	717-675-1780
Fax Number	:	717-675-1776

Provider Business Practice Location Address
First Line	:	1701 CORNWALL ROAD
Second Line	:	SUITE 201
City	:	LEBANON
State	:	PA
Zip	:	17042-7480
Country	:	US
Telephone Number	:	717-675-1780
Fax Number	:	717-675-1776

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	02/21/2025

Similar Medicare Providers

1871457101 — STEPHANIE SCHULTZ GRAMBAU CRNP
Practice Location Address:

1701 CORNWALL RD
LEBANON, PA
17042-7480

Practice Phone: 717-675-1750
Practice Fax:

1265425706 — DR. THOMAS D KOHL MD
Practice Location Address:

1701 CORNWALL RD , STE 201
LEBANON, PA
17042-7480

Practice Phone: 717-675-1750
Practice Fax: 717-675-1787

1417915638 — CAROLYN MARIE BARTELL PA-C
Practice Location Address:

1701 CORNWALL RD , SUITE 101
LEBANON, PA
17042-7480

Practice Phone: 717-675-1788
Practice Fax: 717-675-1800

1801803432 — TARA JO TROUT PA-C
Practice Location Address:

1701 CORNWALL RD , SUITE 101
LEBANON, PA
17042-7480

Practice Phone: 717-675-1788
Practice Fax: 717-675-1800

1720137177 — DR. DENYSE MARIE ALLEN M.D.
Practice Location Address:

1701 CORNWALL RD STE 201
LEBANON, PA
17042-7480

Practice Phone: 717-675-1780
Practice Fax: 717-675-1787

1689991986 — MR. ADAM WOODEN MPT
Practice Location Address:

1701 CORNWALL RD STE 200
LEBANON, PA
17042-7480

Practice Phone: 717-299-4871
Practice Fax: 717-391-2494

Directions to “ STACEY ERIN LATTANZE PA-C” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.