Provider Demographics
NPI:1144241555
Name:BOYER, LISA MARIE (CRNA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:BOYER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:DIEFFENBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:290 CAMP STRAUSS RD
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:PA
Mailing Address - Zip Code:19507-9566
Mailing Address - Country:US
Mailing Address - Phone:717-865-5395
Mailing Address - Fax:
Practice Address - Street 1:290 CAMP STRAUSS RD
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:PA
Practice Address - Zip Code:19507-9566
Practice Address - Country:US
Practice Address - Phone:717-865-5395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN506359L163W00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA078997PSSMedicare ID - Type Unspecified
PAQ15965Medicare UPIN