Healthcare Provider Details

I. General information

NPI: 1932715448
Provider Name (Legal Business Name): LAUREN ASHLEY NEDZELSKI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2020
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 OLD POND RD STE 201
BRIDGEVILLE PA
15017-1270
US

IV. Provider business mailing address

635 SUNSET CIR
CRANBERRY TWP PA
16066-6706
US

V. Phone/Fax

Practice location:
  • Phone: 412-220-7323
  • Fax: 412-220-7325
Mailing address:
  • Phone: 724-630-0655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA061848
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA061848
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: