Provider Demographics
NPI:1265701544
Name:REPPER, LISA JOANNE (NP)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:JOANNE
Last Name:REPPER
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Gender:F
Credentials:NP
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Mailing Address - Street 1:STONY BROOK UNIVERSITY MEDICAL CTR
Mailing Address - Street 2:3 EDMUND PELLEGRINO DR.
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-0001
Mailing Address - Country:US
Mailing Address - Phone:631-638-1000
Mailing Address - Fax:631-444-7530
Practice Address - Street 1:STONY BROOK UNIVERSITY MEDICAL CTR
Practice Address - Street 2:3 EDMUND PELLEGRINO DR.
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-0001
Practice Address - Country:US
Practice Address - Phone:631-638-1000
Practice Address - Fax:631-444-7530
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-15
Last Update Date:2013-02-06
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Provider Licenses
StateLicense IDTaxonomies
NYF305836363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health