MEDICARE: LISA MARKS LISA MARKS CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	SP011122	PA

General Provider Information

NPI Number	:	1114222197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MARKS LISA MARKS CRNP

Provider Business Mailing Address
First Line	:	241 S 6TH ST APT 1803
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19106-3734
Country	:	US
Telephone Number	:	215-925-2480
Fax Number	:

Provider Business Practice Location Address
First Line	:	241 S 6TH ST APT 1803
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19106-3734
Country	:	US
Telephone Number	:	215-925-2480
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2011
Last Update Date	:	01/21/2011

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