NPIMap

Individual provider Active NPI

Stacey Erin Lattanze, PA-C

  • Medical Physician Assistant
  • Lebanon, PA
National Provider Identifier
1629116728
Registry record updated Feb 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
MA002230-L Issued in PA
Practice address
1701 Cornwall Road
Suite 201
Lebanon, PA 17042-7480
Phone
(717) 675-1780
Fax
(717) 675-1776
NPI assigned
Feb 1, 2007
Last updated
Feb 21, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X MA002230-L PA Primary
Surgical Physician Assistant 363AS0400X OA003364 PA

Addresses

Primary practice location

1701 Cornwall Road
Suite 201
Lebanon, PA 17042-7480

Mailing address

1701 Cornwall Rd
Ste 201
Lebanon, PA 17042-7480
Phone (717) 675-1780

Other practice location 1

14 Philadelphia Ave
Shillington, PA 19607-2757
Phone (610) 777-7781

Other practice location 2

2496 Stiegel Pike
Schaefferstown, PA 17088-7021
Phone (717) 949-2777

Other practice location 3

1010 W Crestview Dr
Lebanon, PA 17042-7415
Phone (717) 272-7469

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141009002239 PA Practitioner - Physician Assistant 1456571694 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lancaster General Medical GroupGroup PAC ID 0941103683, 590 clinicians

Practice addresses (Care Compare)

1701 Cornwall Rd
Lebanon, PA 17042-7480

3045 Marietta Ave
Lancaster, PA 17601-1321
Phone (717) 299-4644

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
MA002230-LPAMDMedical Physician Assistant
OA003364PAMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Lancaster General Medical Group CurrentSince Aug 19, 2024 Accepting new patients
Medexpress Urgent Care, PC - Pennsylvania CurrentSince Feb 29, 2020 Accepting new patients
Lancaster General Medical Group CurrentSince Aug 19, 2024 Accepting new patients
Lancaster General Health - Columbia Center CurrentSince Aug 19, 2024 Accepting new patients
Medexpress Urgent Care, PC - Pennsylvania CurrentSince Feb 29, 2020 Accepting new patients
Lancaster General Medical Group Past Accepting new patients
Medexpress Urgent Care, PC - Pennyslvania Past Accepting new patients
Sunrise Pediatrics PC Past Accepting new patients

Locations

4808 Edgmont Ave
Brookhaven, PA 19015
Phone (610) 876-3072

306 N 7th St
Columbia, PA 17512
Phone (717) 684-1500

3045 Marietta Ave
Lancaster, PA 17601
Phone (717) 299-4644

1010 W Crestview Dr
Lebanon, PA 17042
Phone (717) 272-7469

1701 Cornwall Rd
Ste 201
Lebanon, PA 17042
Phone (717) 675-1750

7219 McKnight Rd
Ste F
Pittsburgh, PA 15237
Phone (412) 367-3278

505 Historic Dr
Strasburg, PA 17579
Phone (717) 588-1576

6415 Lincoln Hwy
Wrightsville, PA 17368
Phone (717) 252-1200

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740096000000",
    "number": "1629116728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 CORNWALL RD",
            "address_2": "STE 201",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170427480",
            "telephone_number": "717-675-1780",
            "fax_number": "717-675-1776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 CORNWALL ROAD",
            "address_2": "SUITE 201",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170427480",
            "telephone_number": "717-675-1780",
            "fax_number": "717-675-1776"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14 Philadelphia Ave",
            "address_purpose": "LOCATION",
            "city": "Shillington",
            "state": "PA",
            "postal_code": "196072757",
            "country_code": "US",
            "telephone_number": "610-777-7781",
            "fax_number": "610-777-1275",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2496 Stiegel Pike",
            "address_purpose": "LOCATION",
            "city": "Schaefferstown",
            "state": "PA",
            "postal_code": "170887021",
            "country_code": "US",
            "telephone_number": "717-949-2777",
            "fax_number": "717-949-6925",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1010 W Crestview Dr",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "PA",
            "postal_code": "170427415",
            "country_code": "US",
            "telephone_number": "717-272-7469",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LATTANZE",
        "first_name": "STACEY",
        "middle_name": "ERIN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-01",
        "last_updated": "2025-02-21",
        "certification_date": "2025-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA002230-L",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "PA",
            "license": "OA003364",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lebanon, PA

Sources for this page

Verify at the official NPI Registry.