Provider Demographics
NPI:1265629091
Name:ALEXANDER, LISA M (PA)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:M
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4912 43RD PL NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-4023
Mailing Address - Country:US
Mailing Address - Phone:202-994-0659
Mailing Address - Fax:202-994-2636
Practice Address - Street 1:1525 7TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-3201
Practice Address - Country:US
Practice Address - Phone:202-994-0659
Practice Address - Fax:202-994-2636
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPA30236363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical