Provider Demographics
NPI:1609866086
Name:RICHARDSON, LISA KAY (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:KAY
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11 SHENANGO RD
Mailing Address - Street 2:STE 1
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-1177
Mailing Address - Country:US
Mailing Address - Phone:724-657-1881
Mailing Address - Fax:724-657-9178
Practice Address - Street 1:11 SHENANGO RD
Practice Address - Street 2:STE 1
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-1177
Practice Address - Country:US
Practice Address - Phone:724-657-1881
Practice Address - Fax:724-657-9178
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2011-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP011549363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA903565Medicare ID - Type Unspecified
S39000Medicare UPIN