Provider Demographics
NPI:1518921675
Name:JESAITIS, LISA (NP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:JESAITIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:JAWORSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACNP
Mailing Address - Street 1:308 S ABINGDON ST
Mailing Address - Street 2:ARLINGTON
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-1335
Mailing Address - Country:US
Mailing Address - Phone:571-331-3235
Mailing Address - Fax:
Practice Address - Street 1:3800 RESERVOIR RD NW # MAIN4412
Practice Address - Street 2:WASHINGTON
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-2113
Practice Address - Country:US
Practice Address - Phone:202-444-2062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN66952363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC410337800Medicaid
DC037747100Medicaid