Provider Demographics
NPI:1326000910
Name:KRIEG, LISA T (MSN,RN,FNP-BC,BC-ADM)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:T
Last Name:KRIEG
Suffix:
Gender:F
Credentials:MSN,RN,FNP-BC,BC-ADM
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:B
Other - Last Name:TANNENBAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:413 STUART CIR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-3741
Mailing Address - Country:US
Mailing Address - Phone:804-545-1920
Mailing Address - Fax:804-545-1935
Practice Address - Street 1:413 STUART CIR
Practice Address - Street 2:SUITE 210
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-3741
Practice Address - Country:US
Practice Address - Phone:804-545-1920
Practice Address - Fax:804-545-1935
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164950363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA015455R79OtherMC IDENTIFIER PIN