Provider Demographics
NPI:1346440278
Name:LISA D BEERS
Entity Type:Organization
Organization Name:LISA D BEERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BEERS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:607-865-4623
Mailing Address - Street 1:PO BOX 113
Mailing Address - Street 2:
Mailing Address - City:TROUT CREEK
Mailing Address - State:NY
Mailing Address - Zip Code:13847-0113
Mailing Address - Country:US
Mailing Address - Phone:607-865-4623
Mailing Address - Fax:
Practice Address - Street 1:7949 STATE HWY 206
Practice Address - Street 2:
Practice Address - City:TROUT CREEK
Practice Address - State:NY
Practice Address - Zip Code:13847-0113
Practice Address - Country:US
Practice Address - Phone:607-865-4623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY526521-1305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02569675Medicaid