Provider Demographics
NPI:1326306598
Name:CARMELENGO, LISA ANNEMARIE (RN)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANNEMARIE
Last Name:CARMELENGO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 MEA LN
Mailing Address - Street 2:
Mailing Address - City:BEACH HAVEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08008-3633
Mailing Address - Country:US
Mailing Address - Phone:609-361-1084
Mailing Address - Fax:
Practice Address - Street 1:24 MEA LANE
Practice Address - Street 2:
Practice Address - City:BEACH HAVEN
Practice Address - State:NJ
Practice Address - Zip Code:08008
Practice Address - Country:US
Practice Address - Phone:609-361-1084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26N0O7679900163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse