Basic Information
| Provider Information | |||||||||
| NPI: | 1952751273 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BACCO | ||||||||
| FirstName: | LEA | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 95 LEONARD AVE BLDG 2 | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 153013368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7242233100 | ||||||||
| FaxNumber: | 7242233353 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 WELLNESS WAY | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 153019706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7242506001 | ||||||||
| FaxNumber: | 7242506004 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2016 | ||||||||
| LastUpdateDate: | 10/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WG0000X | RN594370 | PA | N | Nursing Service Providers | Registered Nurse | General Practice | 363LF0000X | SP016345 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.