Provider Demographics
NPI:1821558164
Name:BROWN, LISA (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 MEMORIAL BLVD W
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-6219
Mailing Address - Country:US
Mailing Address - Phone:301-791-7060
Mailing Address - Fax:301-791-8990
Practice Address - Street 1:303 MEMORIAL BLVD W
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-6219
Practice Address - Country:US
Practice Address - Phone:013-791-7060
Practice Address - Fax:301-791-8990
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95011342363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95011342OtherCA BOARD OF REGISTERED NURSING