Provider Demographics
NPI:1518522960
Name:SWEZEY, LISA (NP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:SWEZEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 MARY ANN DR APT 9
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-3795
Mailing Address - Country:US
Mailing Address - Phone:618-803-8388
Mailing Address - Fax:
Practice Address - Street 1:1111 CORPORATE PARK DR STE D
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-2279
Practice Address - Country:US
Practice Address - Phone:434-382-1125
Practice Address - Fax:434-544-2337
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-01
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024177508363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty