Provider Demographics
NPI:1083763817
Name:GRESSEL, LISA W (MPAS, PA-C)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:W
Last Name:GRESSEL
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 E FORT ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355-1508
Mailing Address - Country:US
Mailing Address - Phone:931-728-4477
Mailing Address - Fax:
Practice Address - Street 1:119 E FORT ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-1508
Practice Address - Country:US
Practice Address - Phone:931-728-4477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA0000000727363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1509873Medicaid
TN4191422OtherBCBS OF TN
TN36695632Medicare PIN
TN1509873Medicaid