Provider Demographics
NPI:1518238195
Name:THOMPSON-BARENT, LISA (CRNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:THOMPSON-BARENT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:J
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:6998 CRIDER RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MARS
Mailing Address - State:PA
Mailing Address - Zip Code:16046-2390
Mailing Address - Country:US
Mailing Address - Phone:724-778-1601
Mailing Address - Fax:724-778-1603
Practice Address - Street 1:6998 CRIDER RD
Practice Address - Street 2:SUITE 210
Practice Address - City:MARS
Practice Address - State:PA
Practice Address - Zip Code:16046-2390
Practice Address - Country:US
Practice Address - Phone:724-778-1601
Practice Address - Fax:724-778-1603
Is Sole Proprietor?:No
Enumeration Date:2012-01-13
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP003866B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA12329282OtherCAQH
PA102753710Medicaid
PA235169Medicare PIN