Provider Demographics
NPI:1073509071
Name:MARRERO, LISA ANN (FNPC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:MARRERO
Suffix:
Gender:
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 834
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46527-0834
Mailing Address - Country:US
Mailing Address - Phone:574-364-2592
Mailing Address - Fax:
Practice Address - Street 1:1953 WATERFALL DR STE A
Practice Address - Street 2:
Practice Address - City:NAPPANEE
Practice Address - State:IN
Practice Address - Zip Code:46550-8961
Practice Address - Country:US
Practice Address - Phone:574-773-4101
Practice Address - Fax:574-773-5483
Is Sole Proprietor?:No
Enumeration Date:2005-09-25
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000814A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN232230UUUUMedicare UPIN