Provider Demographics
NPI:1679591994
Name:JOHNSON, LISA ANNE (CRNP, DRNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CRNP, DRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-5008
Mailing Address - Country:US
Mailing Address - Phone:610-327-7710
Mailing Address - Fax:610-705-5652
Practice Address - Street 1:1600 E HIGH ST
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-5008
Practice Address - Country:US
Practice Address - Phone:610-327-7710
Practice Address - Fax:610-705-5652
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008407363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q70662Medicare UPIN
PA102674P31Medicare PIN
PA102674V60Medicare PIN