Provider Demographics
NPI:1891031324
Name:SULLIVAN, LISA MARIE (PA)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:721 ROSELAWN AVE
Mailing Address - Street 2:UNIT C6
Mailing Address - City:MT LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:15228-2260
Mailing Address - Country:US
Mailing Address - Phone:716-523-4048
Mailing Address - Fax:
Practice Address - Street 1:110 FORT COUCH RD
Practice Address - Street 2:SUITE 203
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15241-1030
Practice Address - Country:US
Practice Address - Phone:412-831-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-03
Last Update Date:2014-01-31
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical