Provider Demographics
NPI:1770825747
Name:MCDONALD, LISA HALL (NP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:HALL
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:DIANE
Other - Last Name:VILLABONA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 778
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-8914
Mailing Address - Country:US
Mailing Address - Phone:410-763-8787
Mailing Address - Fax:410-763-8788
Practice Address - Street 1:2540 CENTREVILLE RD
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:MD
Practice Address - Zip Code:21617-2681
Practice Address - Country:US
Practice Address - Phone:410-758-4432
Practice Address - Fax:410-758-1938
Is Sole Proprietor?:No
Enumeration Date:2013-03-18
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR118699363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily