Provider Demographics
NPI:1336496413
Name:KISHBAUGH, LANI L (CRNP)
Entity Type:Individual
Prefix:
First Name:LANI
Middle Name:L
Last Name:KISHBAUGH
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 1:4200 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:COAL TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:17866-9668
Mailing Address - Country:US
Mailing Address - Phone:570-898-9235
Mailing Address - Fax:570-644-4241
Practice Address - Street 1:4200 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:COAL TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:17866-9668
Practice Address - Country:US
Practice Address - Phone:570-898-9235
Practice Address - Fax:570-644-4241
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012253363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health