Provider Demographics
NPI:1578584066
Name:GANZ, LISA R (CRNA)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:R
Last Name:GANZ
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6490
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16512-6490
Mailing Address - Country:US
Mailing Address - Phone:814-480-8732
Mailing Address - Fax:814-456-5524
Practice Address - Street 1:201 STATE ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16550-0002
Practice Address - Country:US
Practice Address - Phone:814-877-2137
Practice Address - Fax:814-877-7049
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN283645L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5043Medicare ID - Type UnspecifiedPA MEDICARE#
S47964Medicare UPIN