Provider Demographics
NPI:1942414842
Name:NOTO, LISA ANN (LAC)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANN
Last Name:NOTO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:119 SOUTH TURNPIKE RD
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:PA
Mailing Address - Zip Code:18414-9511
Mailing Address - Country:US
Mailing Address - Phone:570-563-3713
Mailing Address - Fax:570-563-3716
Practice Address - Street 1:119 SOUTH TURNPIKE RD
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:PA
Practice Address - Zip Code:18414-9511
Practice Address - Country:US
Practice Address - Phone:570-563-3713
Practice Address - Fax:570-563-3716
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAKO000519171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1803432OtherPROVIDER FEP PROGRAM