Provider Demographics
NPI:1770508715
Name:QUINN, LISA P (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:P
Last Name:QUINN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2315 MYRTLE ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-4602
Mailing Address - Country:US
Mailing Address - Phone:814-454-8185
Mailing Address - Fax:814-454-3894
Practice Address - Street 1:2315 MYRTLE ST
Practice Address - Street 2:SUITE 220
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-4602
Practice Address - Country:US
Practice Address - Phone:814-454-8185
Practice Address - Fax:814-454-3894
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP001444G363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q21586Medicare UPIN