Provider Demographics
NPI:1871709550
Name:WILLIAMSON, LISA VANESA (APN)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:VANESA
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
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Mailing Address - Street 1:644 PURCE ST
Mailing Address - Street 2:
Mailing Address - City:HILLSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07205-1717
Mailing Address - Country:US
Mailing Address - Phone:908-686-5786
Mailing Address - Fax:908-686-2618
Practice Address - Street 1:150 BERGEN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2496
Practice Address - Country:US
Practice Address - Phone:973-972-9090
Practice Address - Fax:973-972-7414
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2014-11-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP012764363LA2100X
DELZ-0000127363LA2100X
NJ26NJ00131200363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care