Provider Demographics
NPI:1114997368
Name:JANSSEN, LISA SUZANNE (CRNP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:SUZANNE
Last Name:JANSSEN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4840 CHEVY CHASE DR
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-6420
Mailing Address - Country:US
Mailing Address - Phone:703-869-8019
Mailing Address - Fax:
Practice Address - Street 1:15200 SHADY GROVE RD
Practice Address - Street 2:SUITE 302
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3218
Practice Address - Country:US
Practice Address - Phone:240-453-9182
Practice Address - Fax:240-453-9189
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2010-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR162632363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner