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General NPI Number Information
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NPI Number | 1225035975
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Entity Type | Individual
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Provider Name | COLETTE REBECCA LASEK MD
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Gender | Female
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Dates
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Enumeration Date | 07/07/2005
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Last Update Date | 09/08/2021
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Provider Practice Location Address
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Address Line | 97 PROGRESS BLVD
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City | SHIPPENSBURG
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State | PA
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Zip | 17257-9053
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Country | US
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Telephone | 717-217-6944
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Fax | 717-217-6955
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Provider Business Mailing Address
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Address Line | 785 5TH AVE STE 3
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City | CHAMBERSBURG
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State | PA
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Zip | 17201-4232
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Country | US
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Telephone | 717-263-9555
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Fax | 717-709-6529
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | MD034184E
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License Number State | PA
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