Provider Demographics
NPI:1821209438
Name:FERRILL, LISA A (CNM)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:FERRILL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1440
Mailing Address - Country:US
Mailing Address - Phone:814-375-6560
Mailing Address - Fax:814-372-2848
Practice Address - Street 1:90 BEAVER DR
Practice Address - Street 2:STE 211D
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2449
Practice Address - Country:US
Practice Address - Phone:412-322-4545
Practice Address - Fax:412-322-4546
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMW010383367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD13454Medicare UPIN
PA447271Medicare PIN