Provider Demographics
NPI:1902867427
Name:MIKLES, LISA M (CRNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:MIKLES
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6740 ALEXANDER BELL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-2253
Mailing Address - Country:US
Mailing Address - Phone:410-997-8444
Mailing Address - Fax:410-997-8832
Practice Address - Street 1:6740 ALEXANDER BELL DR STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-2253
Practice Address - Country:US
Practice Address - Phone:410-997-8444
Practice Address - Fax:410-997-8832
Is Sole Proprietor?:No
Enumeration Date:2006-04-01
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR071359363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0025OtherCAREFIRST-DC
MD525683-02OtherCAREFIRST-MD
Q59266Medicare UPIN
MD539P088HMedicare PIN