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General NPI Number Information
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NPI Number | 1952751273
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Entity Type | Individual
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Provider Name | LEA BACCO CRNP
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Gender | Female
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Dates
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Enumeration Date | 06/17/2016
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Last Update Date | 10/19/2021
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Provider Practice Location Address
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Address Line | 100 WELLNESS WAY
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City | WASHINGTON
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State | PA
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Zip | 15301-9706
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Country | US
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Telephone | 724-250-6001
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Fax | 724-250-6004
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Provider Business Mailing Address
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Address Line | 95 LEONARD AVE BLDG 2
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City | WASHINGTON
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State | PA
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Zip | 15301-3368
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Country | US
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Telephone | 724-223-3100
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Fax | 724-223-3353
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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 | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | RN594370
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SP016345
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License Number State | PA
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