Healthcare Provider Details

I. General information

NPI: 1093066961
Provider Name (Legal Business Name): LAUREN LEONE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2012
Last Update Date: 03/25/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PEACH ST SUITE 300
ERIE PA
16507-1423
US

IV. Provider business mailing address

100 PEACH ST SUITE 300
ERIE PA
16507-1423
US

V. Phone/Fax

Practice location:
  • Phone: 814-459-1851
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA055768
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: