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NPI Code Detail

MEDICARE: LISA ANN WHITE PA-C

MEDICARE: LISA ANN WHITE PA-C
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
1363A00000XPhysician Assistant1886MA
2363AS0400XSurgical Physician Assistant00383RI
3363AS0400XSurgical Physician Assistant2425CT

General Provider Information

NPI Number : 1811992076
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA ANN WHITE PA-C
Provider Business Mailing Address
First Line : 326 WASHINGTON ST
Second Line :
City : NORWICH
State : CT
Zip : 06360-2740
Country : US
Telephone Number : 860-889-8331
Fax Number : 860-892-2761
Provider Business Practice Location Address
First Line : 326 WASHINGTON ST
Second Line :
City : NORWICH
State : CT
Zip : 06360-2740
Country : US
Telephone Number : 860-889-8331
Fax Number : 860-892-2761
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2005
Last Update Date : 09/15/2010

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