Provider Demographics
NPI:1942349931
Name:ULMER, LISA MARIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:ULMER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3998 RED LION RD STE 130
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-1443
Mailing Address - Country:US
Mailing Address - Phone:215-612-4151
Mailing Address - Fax:215-612-5265
Practice Address - Street 1:3998 RED LION RD STE 130
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1443
Practice Address - Country:US
Practice Address - Phone:215-612-4151
Practice Address - Fax:215-612-5265
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052818363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical