Provider Demographics
NPI:1649239021
Name:CURTIS, LISA ELMORE (MS, APRN, BC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ELMORE
Last Name:CURTIS
Suffix:
Gender:F
Credentials:MS, APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5261 CARROLLTON PIKE
Mailing Address - Street 2:SUITE B
Mailing Address - City:WOODLAWN
Mailing Address - State:VA
Mailing Address - Zip Code:24381-3030
Mailing Address - Country:US
Mailing Address - Phone:276-238-8876
Mailing Address - Fax:276-238-8886
Practice Address - Street 1:5261 CARROLLTON PIKE
Practice Address - Street 2:SUITE B
Practice Address - City:WOODLAWN
Practice Address - State:VA
Practice Address - Zip Code:24381-3030
Practice Address - Country:US
Practice Address - Phone:276-238-8876
Practice Address - Fax:276-238-8886
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165319363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
DN2980OtherGROUP PTAN
261083931OtherTAX ID
VAVV9714AOtherPTAN
C10361OtherGROUP ORGANIZATION PTAN
VA1649239021Medicaid