Provider Demographics
NPI:1114306321
Name:MOYER, LISA (MSN, CRNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:MOYER
Suffix:
Gender:F
Credentials:MSN, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 E 5TH ST STE 1050
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-4121
Mailing Address - Country:US
Mailing Address - Phone:513-618-2243
Mailing Address - Fax:
Practice Address - Street 1:1787 SENTRY PKWY W BLDG 16
Practice Address - Street 2:SUITE 405
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-2239
Practice Address - Country:US
Practice Address - Phone:877-868-4827
Practice Address - Fax:877-283-0663
Is Sole Proprietor?:No
Enumeration Date:2015-05-20
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP014529363LP2300X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care