Provider Demographics
NPI:1932651700
Name:BRONAUGH, LISA MARIANE (NP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:MARIANE
Last Name:BRONAUGH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:219 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-2913
Mailing Address - Country:US
Mailing Address - Phone:410-822-9133
Mailing Address - Fax:410-822-9513
Practice Address - Street 1:607 DUTCHMANS LN
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-3345
Practice Address - Country:US
Practice Address - Phone:410-822-9133
Practice Address - Fax:410-822-9513
Is Sole Proprietor?:No
Enumeration Date:2016-10-27
Last Update Date:2018-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDR206308363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily