Provider Demographics
NPI:1578390548
Name:PUMMER, LINZI
Entity type:Individual
Prefix:
First Name:LINZI
Middle Name:
Last Name:PUMMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1753 PINEWIND DR
Mailing Address - Street 2:
Mailing Address - City:ALBURTIS
Mailing Address - State:PA
Mailing Address - Zip Code:18011-2709
Mailing Address - Country:US
Mailing Address - Phone:610-390-3991
Mailing Address - Fax:
Practice Address - Street 1:1725 OREGON PIKE STE A100
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4206
Practice Address - Country:US
Practice Address - Phone:717-569-8518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP022638363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics