Provider Demographics
NPI:1700960226
Name:SMITH, LISA M (NP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
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Other - Credentials:
Mailing Address - Street 1:121 NATIONWIDE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-4272
Mailing Address - Country:US
Mailing Address - Phone:434-384-1862
Mailing Address - Fax:434-384-7704
Practice Address - Street 1:121 NATIONWIDE DR
Practice Address - Street 2:SUITE A
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-4272
Practice Address - Country:US
Practice Address - Phone:434-384-1862
Practice Address - Fax:434-384-7704
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024120815363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010249414Medicaid
VA009983G72Medicare ID - Type Unspecified
VAQ45824Medicare UPIN