Provider Demographics
NPI:1740245786
Name:RADER, LISA C (A-NP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:C
Last Name:RADER
Suffix:
Gender:F
Credentials:A-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 SELMA DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601
Mailing Address - Country:US
Mailing Address - Phone:540-678-2800
Mailing Address - Fax:540-678-2859
Practice Address - Street 1:104 SELMA DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601
Practice Address - Country:US
Practice Address - Phone:540-678-2800
Practice Address - Fax:540-678-2859
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VANP0024166267363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA384801OtherANTHEM
VA384801OtherANTHEM
Q27276Medicare UPIN