Provider Demographics
NPI:1770950370
Name:GILBERT, LISA (APRN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:GILBERT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 BELLAMONT LN
Mailing Address - Street 2:
Mailing Address - City:NEW CREEK
Mailing Address - State:WV
Mailing Address - Zip Code:26743-4541
Mailing Address - Country:US
Mailing Address - Phone:304-276-5472
Mailing Address - Fax:
Practice Address - Street 1:514 NEW CREEK HWY STE 1
Practice Address - Street 2:
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726-9526
Practice Address - Country:US
Practice Address - Phone:304-788-6462
Practice Address - Fax:304-788-6555
Is Sole Proprietor?:No
Enumeration Date:2015-08-31
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV89322363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner