Provider Demographics
NPI:1285615500
Name:KNISLEY, LISA P (PA)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:P
Last Name:KNISLEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:844 WASHINGTON RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-6664
Mailing Address - Country:US
Mailing Address - Phone:410-871-0088
Mailing Address - Fax:410-870-0083
Practice Address - Street 1:844 WASHINGTON RD
Practice Address - Street 2:SUITE 102
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6664
Practice Address - Country:US
Practice Address - Phone:410-871-0088
Practice Address - Fax:410-870-0083
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0001028363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
H828Medicare ID - Type Unspecified
S34250Medicare UPIN