Provider Demographics
NPI:1437794146
Name:LEASE, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:LEASE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6398 CHAMBERSBURG RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17222-8331
Mailing Address - Country:US
Mailing Address - Phone:717-377-3610
Mailing Address - Fax:
Practice Address - Street 1:6398 CHAMBERSBURG RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:PA
Practice Address - Zip Code:17222-8331
Practice Address - Country:US
Practice Address - Phone:717-377-3610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-18
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA41813601374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide