Provider Demographics
NPI:1629346796
Name:PEWORCHIK, LISA
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:PEWORCHIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 HALL ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-1523
Mailing Address - Country:US
Mailing Address - Phone:607-735-3710
Mailing Address - Fax:607-735-3709
Practice Address - Street 1:1115 HALL ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-1523
Practice Address - Country:US
Practice Address - Phone:607-735-3710
Practice Address - Fax:607-735-3709
Is Sole Proprietor?:No
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311303163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse