Provider Demographics
NPI:1972650109
Name:SIDDALL, LISA J (FNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:SIDDALL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:21475 RIDGETOP CIR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20166-6580
Mailing Address - Country:US
Mailing Address - Phone:703-444-5000
Mailing Address - Fax:703-444-4999
Practice Address - Street 1:21475 RIDGETOP CIR
Practice Address - Street 2:SUITE 150
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-6580
Practice Address - Country:US
Practice Address - Phone:703-444-5000
Practice Address - Fax:703-444-4999
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2021-04-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDR174726363L00000X
VA0024168490363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner