Provider Demographics
NPI:1528097524
Name:CONNIFF, LISA DAWN (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:DAWN
Last Name:CONNIFF
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:RT 1 BOX 108
Mailing Address - Street 2:
Mailing Address - City:BELINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:26250
Mailing Address - Country:US
Mailing Address - Phone:304-823-1290
Mailing Address - Fax:
Practice Address - Street 1:RT 1 BOX 208
Practice Address - Street 2:
Practice Address - City:ST. GEORGE
Practice Address - State:WV
Practice Address - Zip Code:26287
Practice Address - Country:US
Practice Address - Phone:304-478-3339
Practice Address - Fax:304-478-3311
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV615363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVCOPA25791Medicare PIN
WV511800Medicare Oscar/Certification
WVQ55075Medicare UPIN