Basic Information
Provider Information
NPI: 1265509434
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RIPCHINSKI
FirstName: STACEY
MiddleName: D
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 540 N DUKE ST
Address2: SUITE 110
City: LANCASTER
State: PA
PostalCode: 176022374
CountryCode: US
TelephoneNumber: 7175444995
FaxNumber: 7172996577
Practice Location
Address1: 540 N DUKE ST
Address2: SUITE 110
City: LANCASTER
State: PA
PostalCode: 176022374
CountryCode: US
TelephoneNumber: 7175444995
FaxNumber: 7172996577
Other Information
ProviderEnumerationDate: 11/30/2006
LastUpdateDate: 03/30/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363AS0400XMA052784PAY Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical

No ID Information.


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