Healthcare Provider Details

I. General information

NPI: 1063509990
Provider Name (Legal Business Name): LISA SCALZA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 06/25/2020
Certification Date: 06/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 BREN RD E
MINNETONKA MN
55343-9664
US

IV. Provider business mailing address

244 MAPLE BROOK CT
YORKTOWN HEIGHTS NY
10598-1976
US

V. Phone/Fax

Practice location:
  • Phone: 845-743-5217
  • Fax:
Mailing address:
  • Phone: 914-213-2493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberF430017-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: