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General NPI Number Information
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NPI Number | 1871268904
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Entity Type | Organization
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Legal Business Name | LISALYNN, LLC
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Dates
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Enumeration Date | 08/11/2021
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Last Update Date | 09/07/2023
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Provider Practice Location Address
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Address Line | 1912 BAY RD
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City | DUBOIS
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State | PA
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Zip | 15801
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Country | US
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Telephone | 308-520-2988
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Fax |
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Provider Business Mailing Address
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Address Line | 967 TREASURE LK
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City | DU BOIS
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State | PA
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Zip | 15801-9022
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Country | US
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Telephone | 308-520-2988
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LISA LYNN HENGEN
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Credential | DNP
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Telephone | 308-520-2988
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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