Provider Demographics
NPI:1306060132
Name:HIGHSMITH, LOIS M
Entity type:Individual
Prefix:
First Name:LOIS
Middle Name:M
Last Name:HIGHSMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 N DELAWARE AVE
Mailing Address - Street 2:SUITE 300D
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-4330
Mailing Address - Country:US
Mailing Address - Phone:215-287-2113
Mailing Address - Fax:267-773-4430
Practice Address - Street 1:1080 N DELAWARE AVE
Practice Address - Street 2:SUITE 300D
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-4330
Practice Address - Country:US
Practice Address - Phone:215-287-2113
Practice Address - Fax:267-773-4430
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN286879L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1016028470001Medicaid