Provider Demographics
NPI:1477567592
Name:GEHENIO, LISA S (CRNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:S
Last Name:GEHENIO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 CUMBERLAND ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-5233
Mailing Address - Country:US
Mailing Address - Phone:717-273-6741
Mailing Address - Fax:717-273-6337
Practice Address - Street 1:615 CUMBERLAND ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-5233
Practice Address - Country:US
Practice Address - Phone:717-273-6741
Practice Address - Fax:717-273-6337
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP001495C363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAVP001495COtherLICENSE
PAVP001495COtherLICENSE