Provider Demographics
NPI:1093701757
Name:KEEL, LISA ERIN (NP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ERIN
Last Name:KEEL
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:1101 SAM PERRY BLVD.,
Mailing Address - Street 2:SUITE 211
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401
Mailing Address - Country:US
Mailing Address - Phone:540-372-7792
Mailing Address - Fax:540-372-2073
Practice Address - Street 1:600 N WOLFE ST
Practice Address - Street 2:HALSTED 600
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0005
Practice Address - Country:US
Practice Address - Phone:410-955-5353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024165085363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P47812Medicare UPIN