Basic Information
| Provider Information | |||||||||
| NPI: | 1013381292 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JUAREZ | ||||||||
| FirstName: | LISA | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 OLD YORK ROAD | ||||||||
| Address2: | DIXON BUILDING STE 201 | ||||||||
| City: | ABINGTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154816839 | ||||||||
| FaxNumber: | 2154813515 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 OLD YORK ROAD | ||||||||
| Address2: | DIXON BUILDING STE 201 | ||||||||
| City: | ABINGTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154816839 | ||||||||
| FaxNumber: | 2154813515 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/25/2015 | ||||||||
| LastUpdateDate: | 03/23/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | SP015150 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.