Provider Demographics
NPI:1174128326
Name:CROSS, LISA JEAN (CRNP)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:JEAN
Last Name:CROSS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 BUTZTOWN RD # ADDRESS2
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-3226
Mailing Address - Country:US
Mailing Address - Phone:570-807-3961
Mailing Address - Fax:
Practice Address - Street 1:798 HAUSMAN RD STE 270
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-9103
Practice Address - Country:US
Practice Address - Phone:610-871-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP022890363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily