MEDICARE: FAITH ROSE LALLY NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	SP026087	PA

General Provider Information

NPI Number	:	1942925094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAITH ROSE LALLY NP

Provider Business Mailing Address
First Line	:	444 EAST MARSHALL STREET
Second Line	:	STE 101
City	:	WEST CHESTER
State	:	PA
Zip	:	19380
Country	:	US
Telephone Number	:	610-738-2500
Fax Number	:

Provider Business Practice Location Address
First Line	:	444 EAST MARSHALL STREET
Second Line	:	STE 101
City	:	WEST CHESTER
State	:	PA
Zip	:	19380-5415
Country	:	US
Telephone Number	:	610-738-2500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2022
Last Update Date	:	09/14/2023

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