Healthcare Provider Details

I. General information

NPI: 1023301983
Provider Name (Legal Business Name): LISA WILSON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA BELLETETE

II. Dates (important events)

Enumeration Date: 05/25/2011
Last Update Date: 03/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 LOTHROP ST
PITTSBURGH PA
15213-2536
US

IV. Provider business mailing address

200 LOTHROP ST FORBES TOWER, SUITE 9055
PITTSBURGH PA
15213-2536
US

V. Phone/Fax

Practice location:
  • Phone: 412-647-5909
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP011261
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN273527
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: