Provider Demographics
NPI:1285035592
Name:BROWN, LISA (DNP, PMHNP, FNP-NC)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:DNP, PMHNP, FNP-NC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5004 HONEYGO CENTER DR STE 102-197
Mailing Address - Street 2:
Mailing Address - City:PERRY HALL
Mailing Address - State:MD
Mailing Address - Zip Code:21128-8963
Mailing Address - Country:US
Mailing Address - Phone:410-929-6858
Mailing Address - Fax:443-222-8957
Practice Address - Street 1:5004 HONEYGO CENTER DR STE 102-197
Practice Address - Street 2:
Practice Address - City:PERRY HALL
Practice Address - State:MD
Practice Address - Zip Code:21128-8963
Practice Address - Country:US
Practice Address - Phone:410-929-6858
Practice Address - Fax:442-222-8957
Is Sole Proprietor?:No
Enumeration Date:2014-09-06
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR145174363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD119057101Medicaid
MD1285035592OtherNPI