Provider Demographics
NPI:1760673818
Name:AOULA, LISA L (APRN ANP-C)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:L
Last Name:AOULA
Suffix:
Gender:F
Credentials:APRN ANP-C
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:L
Other - Last Name:ADKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:
Practice Address - Street 1:100 NORTH ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17822-9800
Practice Address - Country:US
Practice Address - Phone:570-271-6045
Practice Address - Fax:570-271-6542
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP029780363L00000X
TXAP116065 /RN 581248363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX302761701Medicaid
TXTXB159747Medicare PIN