Provider Demographics
NPI:1235312117
Name:PAPE, LISA DANIELLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:DANIELLE
Last Name:PAPE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1492 E BROAD ST STE 1201
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-1546
Mailing Address - Country:US
Mailing Address - Phone:614-257-3820
Mailing Address - Fax:614-257-3825
Practice Address - Street 1:1492 E BROAD ST STE 1201
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-1546
Practice Address - Country:US
Practice Address - Phone:614-257-3820
Practice Address - Fax:614-257-3825
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.002231363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant