Provider Demographics
NPI:1952519209
Name:HARRISON, LISA M (PA-C)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:M
Last Name:HARRISON
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:5501 OLD YORK RD
Mailing Address - Street 2:DEPARTMENT OF MEDICINE - KLEIN 363
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-3018
Mailing Address - Country:US
Mailing Address - Phone:215-456-6527
Mailing Address - Fax:215-455-1933
Practice Address - Street 1:5501 OLD YORK RD
Practice Address - Street 2:DEPARTMENT OF MEDICINE - KLEIN 363
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3018
Practice Address - Country:US
Practice Address - Phone:215-456-6527
Practice Address - Fax:215-455-1933
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2015-09-10
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Provider Licenses
StateLicense IDTaxonomies
PAMA051615363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant