Provider Demographics
NPI:1912185687
Name:DEYULIA, LISA (BSN, MSN, ANP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:DEYULIA
Suffix:
Gender:F
Credentials:BSN, MSN, ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10710 CHARTER DR STE G020
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3257
Mailing Address - Country:US
Mailing Address - Phone:410-964-2212
Mailing Address - Fax:
Practice Address - Street 1:10710 CHARTER DR STE G020
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3257
Practice Address - Country:US
Practice Address - Phone:410-964-2212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA660084363LA2200X
MDR213927363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health