Provider Demographics
NPI:1689892333
Name:PANZERA, ALIS K (CRNP)
Entity Type:Individual
Prefix:MS
First Name:ALIS
Middle Name:K
Last Name:PANZERA
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 1:897 HERITAGE RD
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-1329
Mailing Address - Country:US
Mailing Address - Phone:856-727-0653
Mailing Address - Fax:
Practice Address - Street 1:123 RIDGEFIELD RD
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-3812
Practice Address - Country:US
Practice Address - Phone:610-353-4391
Practice Address - Fax:610-356-2730
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007092363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health