Provider Demographics
NPI:1598817108
Name:NERI, LISA A (MSN, CRNP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:A
Last Name:NERI
Suffix:
Gender:F
Credentials:MSN, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 MARY HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460
Mailing Address - Country:US
Mailing Address - Phone:610-917-0454
Mailing Address - Fax:
Practice Address - Street 1:51 VALLEY STREAM PKWY STE 1000
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-1406
Practice Address - Country:US
Practice Address - Phone:833-692-6882
Practice Address - Fax:601-651-2705
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP006022B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P66504Medicare UPIN
PA061106Medicare ID - Type Unspecified