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General NPI Number Information
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NPI Number | 1508657198
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Entity Type | Individual
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Provider Name | BETTY J LACKNER RN
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Gender | Female
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Dates
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Enumeration Date | 05/14/2025
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 2115 TREBELLA CIR
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City | ROSTRAVER TOWNSHIP
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State | PA
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Zip | 15012-3511
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Country | US
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Telephone | 724-322-7876
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Fax | 724-322-7876
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Provider Business Mailing Address
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Address Line | 2115 TREBELLA CIR
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City | ROSTRAVER TOWNSHIP
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State | PA
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Zip | 15012-3511
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Country | US
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Telephone | 724-243-1140
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Fax |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN504177L
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License Number State | PA
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