Provider Demographics
NPI:1023326592
Name:LANIEWICZ, NATALIE L (DO)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:L
Last Name:LANIEWICZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 WATERFORD ST
Mailing Address - Street 2:
Mailing Address - City:EDINBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16412-5517
Mailing Address - Country:US
Mailing Address - Phone:814-734-5021
Mailing Address - Fax:
Practice Address - Street 1:419 WATERFORD ST
Practice Address - Street 2:
Practice Address - City:EDINBORO
Practice Address - State:PA
Practice Address - Zip Code:16412-5517
Practice Address - Country:US
Practice Address - Phone:814-734-5021
Practice Address - Fax:814-734-1433
Is Sole Proprietor?:No
Enumeration Date:2010-09-18
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS015456204D00000X, 207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOS015456OtherUNRESTRICTED PA LICENSE
PA1026896650002Medicaid
PAOTO12722OtherD.O. TRAINING LICENSE
PA237182D7AOtherMEDICARE
PA1026896650002Medicaid
PAOS015456OtherUNRESTRICTED PA LICENSE
TXP8381OtherTEXAS MEDICAL BOARD- FULL LICENSE