Provider Demographics
NPI:1023880424
Name:ESCOBALES, LISSETTE LORENA (NP)
Entity type:Individual
Prefix:
First Name:LISSETTE
Middle Name:LORENA
Last Name:ESCOBALES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7002 BLVD E APT 6A
Mailing Address - Street 2:
Mailing Address - City:GUTTENBERG
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-4906
Mailing Address - Country:US
Mailing Address - Phone:201-885-0664
Mailing Address - Fax:
Practice Address - Street 1:7002 BLVD E APT 6A
Practice Address - Street 2:
Practice Address - City:GUTTENBERG
Practice Address - State:NJ
Practice Address - Zip Code:07093-4906
Practice Address - Country:US
Practice Address - Phone:201-885-0664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR22227700163WM0705X
NY768370163WM0705X
NY353041363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical