Provider Demographics
NPI:1508217134
Name:WEHNER, LISA (NP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:WEHNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 BRISTOL RD
Mailing Address - Street 2:
Mailing Address - City:HARTWICK
Mailing Address - State:NY
Mailing Address - Zip Code:13348-2825
Mailing Address - Country:US
Mailing Address - Phone:607-434-7209
Mailing Address - Fax:
Practice Address - Street 1:225 BRISTOL RD
Practice Address - Street 2:
Practice Address - City:HARTWICK
Practice Address - State:NY
Practice Address - Zip Code:13348-2825
Practice Address - Country:US
Practice Address - Phone:607-434-7209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-24
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333133363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily