Provider Demographics
NPI:1508394347
Name:MEJIA, LISA (ARNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:MEJIA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:ROUNTREE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:81 DEERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-2407
Mailing Address - Country:US
Mailing Address - Phone:954-790-8202
Mailing Address - Fax:
Practice Address - Street 1:1991 BALSLEY RD
Practice Address - Street 2:
Practice Address - City:SENECA FALLS
Practice Address - State:NY
Practice Address - Zip Code:13148-6725
Practice Address - Country:US
Practice Address - Phone:315-539-9229
Practice Address - Fax:315-539-0940
Is Sole Proprietor?:No
Enumeration Date:2017-05-24
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF343193363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily