Provider Demographics
NPI:1174849640
Name:MORROW, LISA (DNP, FNP, LAC)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:MORROW
Suffix:
Gender:F
Credentials:DNP, FNP, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5997 RIVERDALE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-1602
Mailing Address - Country:US
Mailing Address - Phone:717-745-6462
Mailing Address - Fax:
Practice Address - Street 1:5997 RIVERDALE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-1602
Practice Address - Country:US
Practice Address - Phone:914-522-7468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-09
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003483171100000X
NY659224163W00000X
NY338495363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No171100000XOther Service ProvidersAcupuncturist
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY038979967Medicaid
NY038979967Medicaid