Healthcare Provider Details

I. General information

NPI: 1710103601
Provider Name (Legal Business Name): LISA ANGELINE SORTINO-SOWA CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 09/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

446 BELLEVUE AVE
TRENTON NJ
08618-4502
US

IV. Provider business mailing address

3131 PRINCETON PIKE BUILDING 5 SUITE 208
LAWRENCEVILLE NJ
08648-2201
US

V. Phone/Fax

Practice location:
  • Phone: 609-394-4045
  • Fax:
Mailing address:
  • Phone: 609-815-7829
  • Fax: 609-815-7894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NN08157800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: