Provider Demographics
NPI:1629251483
Name:LIPPINCOTT, LISA GAGLIARDI (CRNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:GAGLIARDI
Last Name:LIPPINCOTT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 MARKET ST
Mailing Address - Street 2:7TH FLOOR SUITE 741
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5502
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3701 MARKET ST
Practice Address - Street 2:7TH FLOOR SUITE 741
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-5502
Practice Address - Country:US
Practice Address - Phone:215-349-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-14
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009653363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health