Provider Demographics
NPI:1730964883
Name:HISSAM, LISA HELEN (BSN RN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:HELEN
Last Name:HISSAM
Suffix:
Gender:F
Credentials:BSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 23RD STREET EXT
Mailing Address - Street 2:
Mailing Address - City:SHARPSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15215-2821
Mailing Address - Country:US
Mailing Address - Phone:723-545-1600
Mailing Address - Fax:724-923-6023
Practice Address - Street 1:307 23RD STREET EXT
Practice Address - Street 2:
Practice Address - City:SHARPSBURG
Practice Address - State:PA
Practice Address - Zip Code:15215-2821
Practice Address - Country:US
Practice Address - Phone:724-545-1600
Practice Address - Fax:724-923-6023
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN269444L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse