Provider Demographics
NPI:1104009869
Name:ROUPAS, LISA FOUTS (CRNP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:FOUTS
Last Name:ROUPAS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:FOUTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-7575
Mailing Address - Fax:717-798-3702
Practice Address - Street 1:25 MONUMENT RD STE 105
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-5049
Practice Address - Country:US
Practice Address - Phone:717-851-7575
Practice Address - Fax:717-798-3702
Is Sole Proprietor?:No
Enumeration Date:2007-12-17
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009626363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50074467OtherCAPITAL BLUE CROSS-WMG
PA2008981OtherHIGHMARK BS FREEDOM BLUE
MD918379OtherCAREFIRST MD BCBS
PA210235OtherJOHNS HOPKINS
PA210235OtherJOHNS HOPKINS
PAP00669541Medicare PIN