Provider Demographics
NPI:1871178442
Name:DIANA, LISA C (APN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:C
Last Name:DIANA
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-1106
Mailing Address - Country:US
Mailing Address - Phone:844-362-1735
Mailing Address - Fax:973-290-7495
Practice Address - Street 1:99 BEAUVOIR AVE
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-3533
Practice Address - Country:US
Practice Address - Phone:908-522-2829
Practice Address - Fax:908-522-6147
Is Sole Proprietor?:No
Enumeration Date:2021-03-15
Last Update Date:2025-05-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ26NJ010669900363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner