Healthcare Provider Details

I. General information

NPI: 1699322149
Provider Name (Legal Business Name): LISA ANN ROVELLI CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2019
Last Update Date: 08/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 S FRONT ST FL 5
HARRISBURG PA
17104-1619
US

IV. Provider business mailing address

838 ALLENVIEW DR
MECHANICSBURG PA
17055-6183
US

V. Phone/Fax

Practice location:
  • Phone: 717-580-1159
  • Fax:
Mailing address:
  • Phone: 717-580-1159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN623637
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: