Provider Demographics
NPI:1407053408
Name:MORLEY, LISA ANN (PA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:MORLEY
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:STE 130 PROVIDER ENROLLMENT
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:535 BARNHILL DR
Practice Address - Street 2:STE 420
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5112
Practice Address - Country:US
Practice Address - Phone:317-278-1122
Practice Address - Fax:317-278-1820
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2014-02-18
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Provider Licenses
StateLicense IDTaxonomies
IN10000711A363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN10000711AOtherLICENSE