Provider Demographics
NPI:1225335060
Name:GORDON PEARLMAN, LISA RENEE (FNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:RENEE
Last Name:GORDON PEARLMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 CAMPUS RD
Mailing Address - Street 2:BARD COLLEGE HEALTH SERVICE
Mailing Address - City:ANNANDALE ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12504-9800
Mailing Address - Country:US
Mailing Address - Phone:845-758-7433
Mailing Address - Fax:845-758-7437
Practice Address - Street 1:30 CAMPUS RD
Practice Address - Street 2:BARD COLLEGE HEALTH SERVICE
Practice Address - City:ANNANDALE ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12504-9800
Practice Address - Country:US
Practice Address - Phone:845-758-7433
Practice Address - Fax:845-758-7437
Is Sole Proprietor?:No
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY333484363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily