MEDICARE: LISA KASS CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC3500X	Cardiac Rehabilitation Registered Nurse	26NJ00634300	NJ
2	363LF0000X	Family Nurse Practitioner	SP014197	PA
3	363LF0000X	Family Nurse Practitioner	26NJ00634300	NJ

General Provider Information

NPI Number	:	1073916706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA KASS CRNP

Provider Business Mailing Address
First Line	:	2 CAPITAL WAY STE 356
Second Line	:
City	:	PENNINGTON
State	:	NJ
Zip	:	08534-2521
Country	:	US
Telephone Number	:	609-599-5307
Fax Number	:

Provider Business Practice Location Address
First Line	:	2813 COTTMAN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19149-1421
Country	:	US
Telephone Number	:	215-332-9666
Fax Number	:	267-672-8274

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/08/2014
Last Update Date	:	12/08/2022

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