Provider Demographics
NPI:1710985775
Name:DEGILIO, LISA (NP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:DEGILIO
Suffix:
Gender:F
Credentials:NP
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:13135 LEE JACKSON MEMORIAL HWY
Mailing Address - Street 2:135
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-1907
Mailing Address - Country:US
Mailing Address - Phone:703-961-0488
Mailing Address - Fax:703-961-0178
Practice Address - Street 1:13135 LEE JACKSON MEMORIAL HWY
Practice Address - Street 2:135
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1907
Practice Address - Country:US
Practice Address - Phone:703-961-0488
Practice Address - Fax:703-961-0178
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024167887363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC1710985775Medicare PIN
S83906Medicare UPIN