Provider Demographics
NPI:1407496649
Name:MERRITT, LISA R (NP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:R
Last Name:MERRITT
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:600 IVY ST STE 206
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14905-1627
Mailing Address - Country:US
Mailing Address - Phone:607-271-2050
Mailing Address - Fax:607-271-2071
Practice Address - Street 1:600 ROE AVE FL 4
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14905-1676
Practice Address - Country:US
Practice Address - Phone:607-271-3780
Practice Address - Fax:607-271-3894
Is Sole Proprietor?:No
Enumeration Date:2020-01-15
Last Update Date:2024-09-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY622681-1163W00000X
NY350081363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07546647Medicaid