Provider Demographics
NPI:1386662963
Name:ABBOTT, LISA J (APRN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:APRN
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Other - Credentials:
Mailing Address - Street 1:PO BOX 8500
Mailing Address - Street 2:LOCKBOX 7642
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-7642
Mailing Address - Country:US
Mailing Address - Phone:813-281-8115
Mailing Address - Fax:813-281-8656
Practice Address - Street 1:1310 PUNAHOU ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1027
Practice Address - Country:US
Practice Address - Phone:808-941-4466
Practice Address - Fax:808-951-3718
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2012-11-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
HIAPRN-449363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0051863103Medicaid
P52604Medicare UPIN
H54277Medicare ID - Type Unspecified