Provider Demographics
NPI:1871773002
Name:JONES, LISA MARIE (PA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:JONES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4379 EASTON AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-1483
Mailing Address - Country:US
Mailing Address - Phone:610-814-2424
Mailing Address - Fax:610-814-2425
Practice Address - Street 1:4379 EASTON AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-1483
Practice Address - Country:US
Practice Address - Phone:610-814-2424
Practice Address - Fax:610-814-2425
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA053101363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical