Provider Demographics
NPI:1912362203
Name:WASHINGTON, LISA JUANITA (BSN, RN)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:JUANITA
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6309 HALLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:PA
Mailing Address - Zip Code:15147-2526
Mailing Address - Country:US
Mailing Address - Phone:412-377-9102
Mailing Address - Fax:
Practice Address - Street 1:6309 HALLWOOD DR
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:PA
Practice Address - Zip Code:15147-2526
Practice Address - Country:US
Practice Address - Phone:412-377-9102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-31
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN620599163W00000X, 163WC0400X, 163WP0200X, 163WW0000X, 163WI0500X, 163WX1500X, 163WX0200X, 163WH0200X, 163WP0218X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WX1500XNursing Service ProvidersRegistered NurseOstomy Care
No163WX0200XNursing Service ProvidersRegistered NurseOncology
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WP0218XNursing Service ProvidersRegistered NursePediatric Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1030784200001OtherSTATE OF PA DHS OFFICE OF INTELLECTUAL DISABILITIES PROVIDER NUMBER
PA1030784200002OtherSTATE OF PA DHS OFFICE OF LONG TERM LIVING PROVIDER NUMBER