Provider Demographics
NPI:1508537762
Name:CONEYBEARE, LISA SEGEL (FNP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:SEGEL
Last Name:CONEYBEARE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7759 TREVINO LN
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22043-3501
Mailing Address - Country:US
Mailing Address - Phone:424-206-3474
Mailing Address - Fax:
Practice Address - Street 1:7759 TREVINO LN
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22043-3501
Practice Address - Country:US
Practice Address - Phone:424-206-3474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024182235363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner