Provider Demographics
NPI:1336112515
Name:FERENCE, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:FERENCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 STATE ROUTE 130
Mailing Address - Street 2:
Mailing Address - City:TRAFFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15085-9700
Mailing Address - Country:US
Mailing Address - Phone:412-856-7332
Mailing Address - Fax:
Practice Address - Street 1:101 ORCHARD DR
Practice Address - Street 2:UNIVERSITY CENTER @ LEVEL GREEN
Practice Address - City:TRAFFORD
Practice Address - State:PA
Practice Address - Zip Code:15085-1640
Practice Address - Country:US
Practice Address - Phone:412-856-7332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044667L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAF24642Medicare UPIN
PA025205PD9Medicare ID - Type Unspecified