Basic Information
| Provider Information | |||||||||
| NPI: | 1750558086 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBERTS | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | FNP-BC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LEARN | ||||||||
| OtherFirstName: | LISA | ||||||||
| OtherMiddleName: | M. | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | FNP-BC | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 601 ELMWOOD AVENUE BOX 670 | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146420001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5857848842 | ||||||||
| FaxNumber: | 5708823023 | ||||||||
| Practice Location | |||||||||
| Address1: | 84 CANAL ST STE 8 | ||||||||
| Address2: | |||||||||
| City: | BIG FLATS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 148148968 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6073014141 | ||||||||
| FaxNumber: | 6073014140 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2008 | ||||||||
| LastUpdateDate: | 05/06/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 334727 | NY | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 363LF0000X | SP009779 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.