Healthcare Provider Details

I. General information

NPI: 1922889328
Provider Name (Legal Business Name): LACEY ELIZABETH RINALDI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2023
Last Update Date: 10/11/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 MOTICHKA RD
MADISON TWP PA
18444-7056
US

IV. Provider business mailing address

2310 MOTICHKA RD
MADISON TWP PA
18444-7056
US

V. Phone/Fax

Practice location:
  • Phone: 570-815-1906
  • Fax:
Mailing address:
  • Phone: 570-815-1906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA064817
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: