Basic Information
| Provider Information | |||||||||
| NPI: | 1851472765 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LANDIS | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PITTENGER | ||||||||
| OtherFirstName: | LISA | ||||||||
| OtherMiddleName: | M | ||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2118 SPRING VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176012427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175440150 | ||||||||
| FaxNumber: | 7175440151 | ||||||||
| Practice Location | |||||||||
| Address1: | 2118 SPRING VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176012427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175440150 | ||||||||
| FaxNumber: | 7175440151 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2006 | ||||||||
| LastUpdateDate: | 08/31/2016 | ||||||||
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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 | 363A00000X | MA052788 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 1917691 | 01 | PA | HIGHMARK BLUE SHIELD - FREEDOM BLUE | OTHER | 1602876 | 01 | PA | GATEWAY MEDICARE ASSURED | OTHER |