Provider Demographics
NPI:1073048179
Name:BENGLE, LISA (MSN RN FNP-BC)
Entity Type:Individual
Prefix:MISS
First Name:LISA
Middle Name:
Last Name:BENGLE
Suffix:
Gender:F
Credentials:MSN RN FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 829641
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0001
Mailing Address - Country:US
Mailing Address - Phone:267-370-5296
Mailing Address - Fax:215-230-3725
Practice Address - Street 1:708 N SHADY RETREAT RD STE 5
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-2503
Practice Address - Country:US
Practice Address - Phone:215-348-5888
Practice Address - Fax:215-348-7001
Is Sole Proprietor?:No
Enumeration Date:2017-04-26
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN640726163W00000X
PASP017012363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse