Healthcare Provider Details

I. General information

NPI: 1073048179
Provider Name (Legal Business Name): LISA BENGLE MSN RN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2017
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 N SHADY RETREAT RD STE 5
DOYLESTOWN PA
18901-2503
US

IV. Provider business mailing address

PO BOX 829641
PHILADELPHIA PA
19182-0001
US

V. Phone/Fax

Practice location:
  • Phone: 215-348-5888
  • Fax: 215-348-7001
Mailing address:
  • Phone: 267-370-5296
  • Fax: 215-230-3725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN640726
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP017012
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: