Provider Demographics
NPI:1093472953
Name:DEWITT, LISA (CRNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:DEWITT
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 1:2616 WILMINGTON RD STE A
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-1504
Mailing Address - Country:US
Mailing Address - Phone:724-652-2323
Mailing Address - Fax:724-654-3461
Practice Address - Street 1:2616 WILMINGTON RD STE A
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-1504
Practice Address - Country:US
Practice Address - Phone:724-652-2323
Practice Address - Fax:724-654-3461
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP024940363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP024940OtherCRNP LICENSE
MD6925397OtherDEA LICENSE