Healthcare Provider Details

I. General information

NPI: 1629036108
Provider Name (Legal Business Name): LISA ALISON MILLER PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 S MAIN ST STE 102
GREENSBURG PA
15601
US

IV. Provider business mailing address

1075 S MAIN ST STE 102
GREENSBURG PA
15601-4864
US

V. Phone/Fax

Practice location:
  • Phone: 724-837-2112
  • Fax: 724-691-0864
Mailing address:
  • Phone: 724-837-2112
  • Fax: 724-691-0864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMA051690
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA051690
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: