Lisa Marie Lycksell
Nurse Practitioner (Family)

Address: 3400 Spruce St, 3 Silverstein Building, Philadelphia, PA 19104-4206
Phone: 2156623487

Lisa Marie Lycksell (NPI# 1578848305) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider Identifier (NPI) 1578848305
Entity Type Individual
Full Name Lisa Marie Lycksell
Credential CRNP
Gender Female
Practice Address 3400 Spruce St
3 Silverstein Building
Philadelphia
PA 19104-4206
Practice Telephone 2156623487
Mailing Address 3400 Spruce St
3 Silverstein Building
Philadelphia
PA 19104-4206
Mailing Telephone 2156623487
Sole Proprietor No, this individual is not a Sole Proprietor
Enumeration Date 2011-10-12
Last Update Date 2012-08-07

Taxonomy Codes

Primary Taxonomy Classification Taxonomy Group License Number State
No 363LF0000X Nurse Practitioner · Family Physician Assistants & Advanced Practice Nursing Providers SP011492 PA
Yes 363LF0000X Nurse Practitioner · Family Physician Assistants & Advanced Practice Nursing Providers RN592334 PA

Physician Overview

NPI 1578848305
PAC ID by PECOS 0446424147
Professional Enrollment ID I20121217000245
Full Name Lisa M Lycksell
Organization Legal Name UNIVERSITY OF PENN MEDICAL GROUP
Phone Number 2156623487
Gender F
Graduation Year 2010
Primary Specialty NURSE PRACTITIONER
Group Practice PAC ID 6204730955
Number of Group Practice Members 2317
Accepts Medicare Assignment Y
Report Quality Measures Y

Claims Based Hospital Affiliation

Claim Control Number (CCN) Legal Business Name
390111 HOSPITAL OF UNIV OF PENNSYLVANIA
390223 PENN PRESBYTERIAN MEDICAL CENTER
390179 CHESTER COUNTY HOSPITAL
390226 PENNSYLVANIA HOSPITAL

Office Location

Street Address 3400 SPRUCE ST
3 SILVERSTEIN BUILDING
City PHILADELPHIA
State PA
Zip Code 19104-4206

Providers in the same location

NPI Name Taxonomy Address Enumeration
1063415966 Samuel Isaiah Parry Obstetrics & Gynecology 3400 Spruce St, 2000 Courtyard, Philadelphia, PA 19104-4206 2005-05-24
1902370075 Julie Truong Nurse Practitioner 3400 Spruce St, Philadelphia, PA 19104-4238 2019-01-11
1295209369 Abigael Bethany Whitaker Nurse Practitioner 3400 Spruce St, Philadelphia, PA 19104-4238 2019-01-11
1861964439 Mary Katherine Tonetti Physician Assistant 3400 Spruce St, 2 Dulles, Philadelphia, PA 19104-4238 2018-12-20
1942772744 Nathan Seungjae Cheon Registered Nurse 3400 Spruce St, Philadelphia, PA 19104-4238 2018-12-19
1538631353 Thomas James Alne Nurse Practitioner 3400 Spruce St, Philadelphia, PA 19104-4238 2018-12-18
1609348598 Marlee Corr Hagan Physician Assistant 3400 Spruce St, Philadelphia, PA 19104-4238 2018-12-18
1437621299 Zamia Caridad Diaz Nurse Practitioner 3400 Spruce St, 5 Founders, Philadelphia, PA 19104-4206 2018-12-18
1861964702 Kristen Petra Welch Nurse Practitioner 3400 Spruce St, Philadelphia, PA 19104-4238 2018-12-17
1316418247 Hannah Lan Nurse Practitioner 3400 Spruce St, Philadelphia, PA 19104-4238 2018-12-17
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1033686225 Tony L Brown Nutritionist 3720 Hamilon Street, Philadelphia, PA 19104 2018-10-26
1770076416 Julie H Lichtman Dietitian, Registered 501 S 45th St, Philadelphia, PA 19104 2018-06-07
1679065643 Elyse Nicole Ryan Genetic Counselor, MS Genetic Diagnostic Laboratory, 3620 Hamilton Walk, Anatomy & Chemistry Bldg, Rm 415, Philadelphia, PA 19104 2018-06-05
1154812691 Choudhary Anwar Chahal Internal Medicine 9 Founders Pavilion, 3400 Spruce Street, Philadelphia, PA 19104 2018-05-21
1588154934 Taylor Louise Delaura Student in an Organized Health Care Education/Training Program 4 South Pavilion, Perelman Center for Advanced Medicine, 3400 Civic Center Boulevard, Philadelphia, PA 19104 2018-05-11
1902395536 Ran Barzilay Specialist 3440 Market St, Suite 200, Philadelphia, PA 19104 2018-05-09
1801383294 Antoinette Allen Student in an Organized Health Care Education/Training Program 1 W. Gates, 3400 Spruce Street, Philadelphia, PA 19104 2018-04-20
1326543034 Daniel Du Pont Emergency Medicine 3400 Civic Center Blvd Bldg 421, Philadelphia, PA 19104 2018-03-26
1952809022 Nerida L Williams Registered Nurse 3856 Brown St, Philadelphia, PA 19104 2018-01-24
1609392703 Emma Elizabeth Konieczny Physician Assistant 3401 Civic Center Bvld, Department of Neonatoloy, Philadelphia, PA 19104 2017-08-21
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Taxonomy Information

Taxonomy Code 363LF0000X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Family

Taxonomy Definition

Definition to comeā€¦

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1518437615 Nicole Marie Hartman Nurse Practitioner 4508 Pearce St, Philadelphia, PA 19124-4124 2018-11-30
1184191108 Sharon Marie Thompson Nurse Practitioner School District of Philadelphia/school Health Services, 440 North Broad Street, Philadelphia, PA 19130 2018-10-29
1386110021 Megan Anne Drozdowski Nurse Practitioner 232 Delmar St, Philadelphia, PA 19128-4501 2018-10-21
1356823959 Geenander Kaur Raju Nurse Practitioner 6062 Ridge Ave, Philadelphia, PA 19128-1647 2018-08-30
1558856310 Stefanie Pepper Nurse Practitioner 1071 West Beacon St., Philadelphia, MS 38350 2018-06-25
1093207961 Xiomara Jimenez Nurse Practitioner 1200 Callowhill St Ste 102, Philadelphia, PA 19123-3658 2018-06-05
1477045656 Susannah H Magrane Nurse Practitioner 1008 S 22nd St, Philadelphia, PA 19146-2510 2018-06-04
1285126730 Erin Elizabeth Held Nurse Practitioner Maria De Los Santos Health Center 401 W Allegheny Ave, Philadelphia, PA 19133-3644 2018-05-31
1720579840 Catherine M Black Nurse Practitioner 800 Walnut St Fl 10, Philadelphia, PA 19107-5176 2018-05-24
1639669120 Jasmine Denia Reid Nurse Practitioner 640 N Broad St Apt 202, Philadelphia, PA 19130-3420 2018-05-10
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Competitor

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City PHILADELPHIA
Zip Code 19104

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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