Provider Demographics
NPI:1437594900
Name:NOLT, LIZETTE PEREZ (MD)
Entity Type:Individual
Prefix:
First Name:LIZETTE
Middle Name:PEREZ
Last Name:NOLT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LIZETTE
Other - Middle Name:
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:950 S OCTORARA TRL
Mailing Address - Street 2:
Mailing Address - City:PARKESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:19365-2100
Mailing Address - Country:US
Mailing Address - Phone:610-857-6648
Mailing Address - Fax:610-857-6638
Practice Address - Street 1:950 S OCTORARA TRL
Practice Address - Street 2:
Practice Address - City:PARKESBURG
Practice Address - State:PA
Practice Address - Zip Code:19365-2100
Practice Address - Country:US
Practice Address - Phone:610-857-6648
Practice Address - Fax:610-857-6638
Is Sole Proprietor?:No
Enumeration Date:2013-05-09
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD462814207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine