Provider Demographics
NPI:1811704802
Name:DILELLO, LISA (CRNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:DILELLO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 GRAVEL HILL RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-1313
Mailing Address - Country:US
Mailing Address - Phone:215-313-0847
Mailing Address - Fax:
Practice Address - Street 1:595 E LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:ST DAVIDS
Practice Address - State:PA
Practice Address - Zip Code:19087-5111
Practice Address - Country:US
Practice Address - Phone:215-313-0847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP031370363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health