Healthcare Provider Details

I. General information

NPI: 1902208838
Provider Name (Legal Business Name): LACEY LOWMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LACEY JAMISON

II. Dates (important events)

Enumeration Date: 09/23/2014
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 E ADAMS ST
COCHRANTON PA
16314-8604
US

IV. Provider business mailing address

675 N BROAD STREET EXT STE 3
GROVE CITY PA
16127-5805
US

V. Phone/Fax

Practice location:
  • Phone: 814-425-2981
  • Fax: 814-425-3433
Mailing address:
  • Phone: 724-458-0232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP014199
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: