Provider Demographics
NPI:1407872096
Name:HYPNAR, LISA ANNE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANNE
Last Name:HYPNAR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 DICKSON LN
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-3336
Mailing Address - Country:US
Mailing Address - Phone:248-762-1678
Mailing Address - Fax:
Practice Address - Street 1:910 DICKSON LN
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-3336
Practice Address - Country:US
Practice Address - Phone:248-762-1678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601001286363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIS01884Medicare UPIN
MIP06510005Medicare ID - Type Unspecified