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General NPI Number Information
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NPI Number | 1679879969
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Entity Type | Individual
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Provider Name | LISA N GOODWILL PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/03/2011
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Last Update Date | 07/03/2024
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Provider Practice Location Address
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Address Line | 145 PLEASANT DR
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City | WARREN
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State | PA
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Zip | 16365-3371
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Country | US
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Telephone | 814-723-8023
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Fax |
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Provider Business Mailing Address
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Address Line | 2 W CRESCENT PARK
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City | WARREN
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State | PA
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Zip | 16365-2111
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Country | US
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Telephone | 814-723-4973
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Fax | 814-723-6095
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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 | MA054786
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License Number State | PA
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