Provider Demographics
NPI:1770555914
Name:ADAMS-VACHERESSE, LISA ANN (CRNA)
Entity type:Individual
Prefix:PROF
First Name:LISA
Middle Name:ANN
Last Name:ADAMS-VACHERESSE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 SENECA ST APT C
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-2664
Mailing Address - Country:US
Mailing Address - Phone:304-374-1277
Mailing Address - Fax:
Practice Address - Street 1:601 COLLIERS WAY
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-5014
Practice Address - Country:US
Practice Address - Phone:304-233-2455
Practice Address - Fax:304-233-6073
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN327537L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101236182Medicaid
PA087478FEVMedicare ID - Type Unspecified