Provider Demographics
NPI:1326366477
Name:LEE, LISA B (CRNP-F)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:B
Last Name:LEE
Suffix:
Gender:F
Credentials:CRNP-F
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 79632
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-0632
Mailing Address - Country:US
Mailing Address - Phone:301-762-5020
Mailing Address - Fax:301-309-3783
Practice Address - Street 1:1201 SEVEN LOCKS RD
Practice Address - Street 2:SUITE 111
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20854-2931
Practice Address - Country:US
Practice Address - Phone:301-762-5020
Practice Address - Fax:301-294-7569
Is Sole Proprietor?:No
Enumeration Date:2010-05-13
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR089372363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDDB9417OtherMEDICARE RAILROAD PALMETTO
MD005FMedicare PIN
DC376546Medicare PIN
MDVA05Medicare PIN