Provider Demographics
NPI:1164855839
Name:IGIDBASHIAN, LISA M (CRNP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:M
Last Name:IGIDBASHIAN
Suffix:
Gender:F
Credentials:CRNP
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Mailing Address - Street 1:41 ROBERTS RD
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-2011
Mailing Address - Country:US
Mailing Address - Phone:610-356-6392
Mailing Address - Fax:
Practice Address - Street 1:100 LANCASTER AVENUE
Practice Address - Street 2:SUITE 280 LANKENAU MEDICAL SCIENCE
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096
Practice Address - Country:US
Practice Address - Phone:610-896-9255
Practice Address - Fax:610-896-1947
Is Sole Proprietor?:No
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP011683363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily