Provider Demographics
NPI:1942361902
Name:DOWNS, LISA (CRNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:DOWNS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 JARRETT AVE.
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE PA 19046
Mailing Address - State:PA
Mailing Address - Zip Code:19046
Mailing Address - Country:US
Mailing Address - Phone:215-663-1264
Mailing Address - Fax:
Practice Address - Street 1:62 JARRETT AVE
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:PA
Practice Address - Zip Code:19046-4221
Practice Address - Country:US
Practice Address - Phone:215-663-1264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP005336B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP36638Medicare UPIN
PA049736Medicare ID - Type Unspecified