Provider Demographics
NPI:1164606877
Name:HARDY, LISA A (CRNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:HARDY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:A
Other - Last Name:VENIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:805 SIR THOMAS COURT
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-4839
Mailing Address - Country:US
Mailing Address - Phone:717-657-3030
Mailing Address - Fax:717-671-0091
Practice Address - Street 1:805 SIR THOMAS COURT
Practice Address - Street 2:2ND FLOOR
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-4839
Practice Address - Country:US
Practice Address - Phone:717-657-3030
Practice Address - Fax:717-671-0091
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007185363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1032108730005Medicaid