Individual
LISA L ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPAS, PA-C
Contact information
Practice address
102 TECHNOLOGY DR, SUITE 230, BUTLER, PA 16001-1784
(877) 661-3376
Mailing address
102 TECHNOLOGY DRIVE, SUITE 230, BUTLER, PA 16001
(877) 661-3376
(724) 482-2212
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA054156
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA054156
LICENSE #
PA
Enumeration date
03/12/2010
Last updated
11/15/2016
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