Provider Demographics
NPI:1336221431
Name:SALVATO, LISA R (CRNP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:R
Last Name:SALVATO
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 1:2134 SANDY DR STE 16
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-2292
Mailing Address - Country:US
Mailing Address - Phone:814-272-5805
Mailing Address - Fax:814-272-0110
Practice Address - Street 1:2134 SANDY DR STE 16
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-2292
Practice Address - Country:US
Practice Address - Phone:814-272-5805
Practice Address - Fax:814-272-0110
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009155363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner