Provider Demographics
NPI:1619406824
Name:GARBER, LISA FRETZ (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:FRETZ
Last Name:GARBER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:FRETZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:713 WYNDMOOR AVE
Mailing Address - Street 2:
Mailing Address - City:WYNDMOOR
Mailing Address - State:PA
Mailing Address - Zip Code:19038-7952
Mailing Address - Country:US
Mailing Address - Phone:267-625-8505
Mailing Address - Fax:
Practice Address - Street 1:1690 BIG OAK RD
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-6421
Practice Address - Country:US
Practice Address - Phone:215-493-1750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-09
Last Update Date:2017-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP017343363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics