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General NPI Number Information
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NPI Number | 1295810448
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Entity Type | Individual
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Provider Name | LISA MARIE BASYE PAC
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Gender | Female
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 02/25/2025
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Provider Practice Location Address
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Address Line | 17978 STATE RT. 55
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City | BAKER
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State | WV
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Zip | 26801-0097
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Country | US
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Telephone | 304-897-5915
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Fax |
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Provider Business Mailing Address
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Address Line | 1900 SPERRY RUN RD
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City | RIO
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State | WV
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Zip | 26755
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Country | US
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Telephone | 304-897-5933
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 345
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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