Provider Demographics
NPI:1104054428
Name:ANWEILER, LISA (ANP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:ANWEILER
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 TENNYSON CIR
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-2233
Mailing Address - Country:US
Mailing Address - Phone:315-794-9234
Mailing Address - Fax:
Practice Address - Street 1:300 MERIDIAN CENTRE BLVD
Practice Address - Street 2:STE 320
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3981
Practice Address - Country:US
Practice Address - Phone:315-794-9234
Practice Address - Fax:585-463-3105
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305124363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health