Provider Demographics
NPI:1588049258
Name:PARNELL, LISA (PMHNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:PARNELL
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP
Mailing Address - Street 1:536 WINTERGREEN WAY
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-4842
Mailing Address - Country:US
Mailing Address - Phone:585-576-8825
Mailing Address - Fax:
Practice Address - Street 1:200 EAST RIVER ROAD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623
Practice Address - Country:US
Practice Address - Phone:585-273-4682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-23
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF401871-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health