Provider Demographics
NPI:1225665011
Name:GASTAN, LISA DAWN (CRNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:DAWN
Last Name:GASTAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 S TWIN LAKES BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-1827
Mailing Address - Country:US
Mailing Address - Phone:732-856-0919
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER BLVD STE 336
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-3902
Practice Address - Country:US
Practice Address - Phone:610-447-6647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-24
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP021652363LF0000X
DELG-0001359363LF0000X
MDAC004405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily