Provider Demographics
NPI:1902002207
Name:MOSER, LISA A (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:A
Last Name:MOSER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2 READS WAY
Mailing Address - Street 2:STE. 201
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-1630
Mailing Address - Country:US
Mailing Address - Phone:302-709-4709
Mailing Address - Fax:302-709-4551
Practice Address - Street 1:4755 OGLETOWN STANTON ROAD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19718-1320
Practice Address - Country:US
Practice Address - Phone:302-733-1000
Practice Address - Fax:302-733-2685
Is Sole Proprietor?:No
Enumeration Date:2007-06-23
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL6-0A00739367500000X
DEL6DA00739367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE447287Y0JMedicare UPIN