Provider Demographics
NPI:1255982906
Name:LEWIS, LISA BRADNER (NP-C)
Entity type:Individual
Prefix:MISS
First Name:LISA
Middle Name:BRADNER
Last Name:LEWIS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 43
Mailing Address - Street 2:
Mailing Address - City:CALLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:24530-0043
Mailing Address - Country:US
Mailing Address - Phone:434-770-5731
Mailing Address - Fax:
Practice Address - Street 1:109 BRIDGE ST STE 202
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-1222
Practice Address - Country:US
Practice Address - Phone:434-792-5964
Practice Address - Fax:434-792-5971
Is Sole Proprietor?:No
Enumeration Date:2019-09-24
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024178301363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024178301OtherVA BOARD OF NURSING