Provider Demographics
NPI:1376506923
Name:LISA, ROSALIE (CRNP)
Entity type:Individual
Prefix:
First Name:ROSALIE
Middle Name:
Last Name:LISA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1597 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-3224
Mailing Address - Country:US
Mailing Address - Phone:610-326-6732
Mailing Address - Fax:610-326-9652
Practice Address - Street 1:1597 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-3224
Practice Address - Country:US
Practice Address - Phone:610-326-6732
Practice Address - Fax:610-326-9652
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP001710G363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA032156HLTMedicare ID - Type Unspecified