Provider Demographics
NPI:1720515620
Name:SCHIMITSCH, LISA (RN , PNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:SCHIMITSCH
Suffix:
Gender:F
Credentials:RN , PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 WHETMORE DR
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-2919
Mailing Address - Country:US
Mailing Address - Phone:516-297-1169
Mailing Address - Fax:
Practice Address - Street 1:6 WHETMORE DR
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-2919
Practice Address - Country:US
Practice Address - Phone:516-297-1169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF381542-1363LP0200X
NY392560-1163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics