Provider Demographics
NPI:1326558545
Name:LAMONT, ELLYSE LOPEZ (FNP-C)
Entity Type:Individual
Prefix:
First Name:ELLYSE
Middle Name:LOPEZ
Last Name:LAMONT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 CHARTERHOUSE ST
Mailing Address - Street 2:
Mailing Address - City:FALLING WATERS
Mailing Address - State:WV
Mailing Address - Zip Code:25419-1698
Mailing Address - Country:US
Mailing Address - Phone:240-818-7400
Mailing Address - Fax:
Practice Address - Street 1:186 EASTERN BLVD N
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5843
Practice Address - Country:US
Practice Address - Phone:301-302-7837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-02
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135273207Q00000X, 363LF0000X
MDR131456363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty