Provider Demographics
NPI:1295032928
Name:STANCICK, LISA MARIE (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:LISA
Middle Name:MARIE
Last Name:STANCICK
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:PO BOX 13579
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19612-3579
Mailing Address - Country:US
Mailing Address - Phone:484-628-1324
Mailing Address - Fax:
Practice Address - Street 1:1139 BEN FRANKLIN HWY W STE 114
Practice Address - Street 2:
Practice Address - City:DOUGLASSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19518-1853
Practice Address - Country:US
Practice Address - Phone:610-385-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-15
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0004711363AM0700X
PAMA054748363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD238987ZARMedicare PIN