Provider Demographics
NPI:1578807293
Name:DUGGER, LISA BLACKMON (APRN, ACNS-BC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:BLACKMON
Last Name:DUGGER
Suffix:
Gender:F
Credentials:APRN, ACNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9819 YOAKUM DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-1437
Mailing Address - Country:US
Mailing Address - Phone:310-423-5098
Mailing Address - Fax:
Practice Address - Street 1:9819 YOAKUM DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-1437
Practice Address - Country:US
Practice Address - Phone:310-423-5098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-19
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX674722364SA2200X
CA95043380163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health