Provider Demographics
NPI:1669837795
Name:SPANGENBERG, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:SPANGENBERG
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 1:321 SPRUCE ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503-1400
Mailing Address - Country:US
Mailing Address - Phone:570-687-0589
Mailing Address - Fax:
Practice Address - Street 1:321 SPRUCE ST
Practice Address - Street 2:SUITE 800
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1400
Practice Address - Country:US
Practice Address - Phone:570-687-0589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-16
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN334165L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse