Provider Demographics
NPI:1437500386
Name:DOOLEY, LISA ANN (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:DOOLEY
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 MIRACLE LN
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:24064-3245
Mailing Address - Country:US
Mailing Address - Phone:540-598-9555
Mailing Address - Fax:540-977-0753
Practice Address - Street 1:1906 BELLEVIEW AVE SE
Practice Address - Street 2:12TH FLOOR, SOUTH TOWER
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-1838
Practice Address - Country:US
Practice Address - Phone:540-853-0215
Practice Address - Fax:540-342-0913
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-22
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001208859163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant