Provider Demographics
NPI:1205876497
Name:GILL, LISA (CRNP)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:GILL
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 1:8765 STENTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:WYNDMOOR
Mailing Address - State:PA
Mailing Address - Zip Code:19038-8317
Mailing Address - Country:US
Mailing Address - Phone:215-836-2440
Mailing Address - Fax:215-836-2448
Practice Address - Street 1:8765 STENTON AVENUE
Practice Address - Street 2:
Practice Address - City:WYNDMOOR
Practice Address - State:PA
Practice Address - Zip Code:19038-8317
Practice Address - Country:US
Practice Address - Phone:215-836-2440
Practice Address - Fax:215-836-2448
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN254164L163W00000X
PASP008340363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAQ69592Medicare UPIN