Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Lisa Anne Dewilde, FNP

Individual provider Family Nurse Practitioner · NPI 1548782204

Lisa Anne Dewilde, FNP is a Nurse Practitioner in Newark, New York. Qualified in 2017, 9 years ago. Practices with Newark Wayne Community Hospital, a 133-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in New York.

Years since qualifying
9
Licensed in
NY
In the registry since
2017
What do these letters mean?
FNP — Family Nurse Practitioner
A nurse practitioner who treats patients of all ages, much like a family doctor.

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Practice location Address checks out

1200 Driving Park Ave
Newark, NY 14513-1090
Phone: (315) 359-2123
Fax: (315) 359-2167
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 2 Coulter Rd, Clifton Springs, NY 14432-1122 — (315) 462-9561

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence F3418541 (NY)

Record details

NPI number1548782204
Entity typeIndividual (Type 1)
GenderFemale
Credentials FNP
Sole proprietorNo
NPI enumeratedJuly 13, 2017
Last updated in NPPESMay 22, 2026
Certification dateMay 22, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Group practice Newark Wayne Community Hospital — 133 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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