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General NPI Number Information
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NPI Number | 1447218789
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Entity Type | Individual
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Provider Name | LISA C BRENIZE PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 10/16/2025
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Provider Practice Location Address
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Address Line | 4760 UNION DEPOSIT RD SUITE 100
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City | HARRISBURG
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State | PA
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Zip | 17111-3744
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Country | US
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Telephone | 717-545-9811
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Fax | 717-545-9979
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Provider Business Mailing Address
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Address Line | 4760 UNION DEPOSIT RD STE 100
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City | HARRISBURG
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State | PA
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Zip | 17111-3744
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Country | US
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Telephone | 717-545-9811
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Fax | 717-545-9979
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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 | MA051112
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA61614209
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License Number State | WA
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