Provider Demographics
NPI:1619164878
Name:LISLE, DOROTHY S (PA-C)
Entity Type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:S
Last Name:LISLE
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:174 BUCKAROO LN
Practice Address - Street 2:
Practice Address - City:BELLEFONTE
Practice Address - State:PA
Practice Address - Zip Code:16823-9119
Practice Address - Country:US
Practice Address - Phone:814-353-1030
Practice Address - Fax:814-353-1053
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2020-08-24
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Provider Licenses
StateLicense IDTaxonomies
PAMA057428363A00000X
MN1046363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant