Provider Demographics
NPI:1851472765
Name:LANDIS, LISA M (PA-C)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:LANDIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:PITTENGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2118 SPRING VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2427
Mailing Address - Country:US
Mailing Address - Phone:717-544-0150
Mailing Address - Fax:717-544-0151
Practice Address - Street 1:2118 SPRING VALLEY RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2427
Practice Address - Country:US
Practice Address - Phone:717-544-0150
Practice Address - Fax:717-544-0151
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052788363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1917691OtherHIGHMARK BLUE SHIELD - FREEDOM BLUE
PA1602876OtherGATEWAY MEDICARE ASSURED
PA230524Medicare PIN
PA230524FLTMedicare PIN