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General NPI Number Information
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NPI Number | 1508524042
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Entity Type | Individual
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Provider Name | LISA ANN AVENT PCA CHHA
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Gender | Female
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Dates
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Enumeration Date | 12/01/2021
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Last Update Date | 12/01/2021
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Provider Practice Location Address
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Address Line | 68 HAWTHORNE AVE
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City | HAWTHORNE
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State | NJ
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Zip | 07506-1311
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Country | US
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Telephone | 973-870-1973
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Fax |
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Provider Business Mailing Address
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Address Line | 68 HAWTHORNE AVE
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City | HAWTHORNE
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State | NJ
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Zip | 07506-1311
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Country | US
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Telephone | 973-870-1973
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | N0000529720
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License Number State | NJ
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