Provider Demographics
NPI:1275159055
Name:UMPA, LISA FRANCES
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:FRANCES
Last Name:UMPA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 SAINT GEORGE BARBER RD
Mailing Address - Street 2:
Mailing Address - City:DAVIDSONVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21035-1315
Mailing Address - Country:US
Mailing Address - Phone:614-499-7226
Mailing Address - Fax:
Practice Address - Street 1:695 KINKAID RD
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21402-1006
Practice Address - Country:US
Practice Address - Phone:410-293-2273
Practice Address - Fax:410-293-1163
Is Sole Proprietor?:No
Enumeration Date:2020-06-17
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.350995363LS0200X
OHAPRN.CNP.0032018363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LS0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerSchool