Provider Demographics
NPI:1043548100
Name:ANDERSSON, LISA ANN (NP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANN
Last Name:ANDERSSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:HAPEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:100 PARK STREET
Mailing Address - Street 2:GLENS FALLS HOSPITAL - CREDENTIALING
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801
Mailing Address - Country:US
Mailing Address - Phone:518-926-5924
Mailing Address - Fax:518-926-6983
Practice Address - Street 1:100 PARK STREET
Practice Address - Street 2:GLENS FALLS HOSPITAL - PALLIATIVE CARE
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801
Practice Address - Country:US
Practice Address - Phone:518-926-3326
Practice Address - Fax:518-926-5917
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-01
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00267100363LA2200X
NYF305155-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF305155OtherNEW YORK STATE LICENSE