Organization · Type 2 NPI
Penn Medicine LGHP Geriatrics
Family Nurse Practitioner · Willow Street, PA
NPI number
1306213020
Active
Practice location
212 Willow Lakes Dr., Suite 101
Willow Street, PA 17584
Mailing address
212 Willow Valley Lakes Dr Ste 101
Willow Street, PA 17584-9668
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | None listed |
| Family Nurse Practitioner Primary | 363LF0000X | None listed |
Family Nurse Practitioner: Definition to come...
About NPI 1306213020
Penn Medicine LGHP Geriatrics's National Provider Identifier is 1306213020, issued on Aug 28, 2015. The primary taxonomy on file is Family Nurse Practitioner (363LF0000X), and the practice location is in Willow Street, PA. The record was last updated on Sep 4, 2025.