Provider Demographics
NPI:1750558086
Name:ROBERTS, LISA MARIE (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:MARIE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:LEARN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:601 ELMWOOD AVENUE BOX 670
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-784-8842
Mailing Address - Fax:570-882-3023
Practice Address - Street 1:84 CANAL ST STE 8
Practice Address - Street 2:
Practice Address - City:BIG FLATS
Practice Address - State:NY
Practice Address - Zip Code:14814-8968
Practice Address - Country:US
Practice Address - Phone:607-301-4141
Practice Address - Fax:607-301-4140
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY334727207T00000X
PASP009779363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery