Provider Demographics
NPI:1508178484
Name:PAPPA, LISA J (PMH-NP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:J
Last Name:PAPPA
Suffix:
Gender:F
Credentials:PMH-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7945 SHIRE LN
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-8732
Mailing Address - Country:US
Mailing Address - Phone:585-398-7505
Mailing Address - Fax:
Practice Address - Street 1:4887 STATE ROUTE 96A
Practice Address - Street 2:HILLSIDE CHILDRENS CENTER
Practice Address - City:ROMULUS
Practice Address - State:NY
Practice Address - Zip Code:14541-9767
Practice Address - Country:US
Practice Address - Phone:315-585-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF401247-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health