Lisa Devineni, CRNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

VP004823B Issued in PA

Practice address

315 Locust St
2ND Floor
Johnstown, PA 15901-1651

Phone

(814) 534-6750

Fax

(814) 534-6760

NPI assigned

Jun 16, 2005

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Icare Medical

  • Urgent Care Clinic/Center
  • Johnstown, PA
  • NPI 1912290008
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1118880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1413504000000",
    "number": "1003811175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1086 FRANKLIN ST",
            "city": "JOHNSTOWN",
            "state": "PA",
            "postal_code": "159054305",
            "telephone_number": "814-410-8300",
            "fax_number": "814-410-8331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 LOCUST ST",
            "address_2": "2ND FLOOR",
            "city": "JOHNSTOWN",
            "state": "PA",
            "postal_code": "159011651",
            "telephone_number": "814-534-6750",
            "fax_number": "814-534-6760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEVINENI",
        "first_name": "LISA",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-16",
        "last_updated": "2014-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "PA",
            "license": "VP004823B",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rick A. Desalvo, O.T.
• Stephanie Marie Despot, OT
• Amber Desrochers, MS CCC-SLP
• Danielle Ayers Destfino, CRNP, FNP-C
• Jenna Rachel Deutch, M.A.
• Rajsekhar Devineni, MD
• Mario Deyulis, D.O.
• Anuradha M Dharbhamulla, M.D.
• Venkata R Dharbhamulla, MD
• Dialcare Dialysis LLC

• Nurse Practitioner in Johnstown, PA
• Providers in Johnstown, PA by specialty
• Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.