Provider Demographics
NPI:1801952122
Name:LISA, TERRI-ANN C (RN)
Entity type:Individual
Prefix:MRS
First Name:TERRI-ANN
Middle Name:C
Last Name:LISA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 COURTNEY LN
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-6158
Mailing Address - Country:US
Mailing Address - Phone:845-278-2086
Mailing Address - Fax:
Practice Address - Street 1:12 COURTNEY LN
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-6158
Practice Address - Country:US
Practice Address - Phone:845-278-2086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY521999-1163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice