Provider Demographics
NPI:1366524092
Name:ROJESKI, LISA ALDRIN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ALDRIN
Last Name:ROJESKI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2345 COVINGTON PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-9302
Mailing Address - Country:US
Mailing Address - Phone:479-521-1705
Mailing Address - Fax:
Practice Address - Street 1:4038 N REMINGTON DR
Practice Address - Street 2:SUITE 4
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-6345
Practice Address - Country:US
Practice Address - Phone:479-444-6522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP-T0618363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP16102Medicare UPIN