Healthcare Provider Details

I. General information

NPI: 1104899301
Provider Name (Legal Business Name): LISA ANN FEDORA CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 06/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1671 CROOKED OAK DR
LANCASTER PA
17601-4269
US

IV. Provider business mailing address

1671 CROOKED OAK DR
LANCASTER PA
17601-4269
US

V. Phone/Fax

Practice location:
  • Phone: 717-569-5331
  • Fax: 717-569-5331
Mailing address:
  • Phone: 717-569-5331
  • Fax: 717-569-5331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP008664
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: