Provider Demographics
NPI:1376946319
Name:PIETRAGALLO, LISAMARIE (NP-C)
Entity Type:Individual
Prefix:
First Name:LISAMARIE
Middle Name:
Last Name:PIETRAGALLO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9375 E MARKET ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-5552
Mailing Address - Country:US
Mailing Address - Phone:330-609-5089
Mailing Address - Fax:
Practice Address - Street 1:9375 E MARKET ST
Practice Address - Street 2:SUITE 1
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-5552
Practice Address - Country:US
Practice Address - Phone:330-609-5089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.-16648-NP363LF0000X
OH16648-NP363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care