Provider Demographics
NPI:1801807797
Name:BEHNEKE, LISA L (PAC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:L
Last Name:BEHNEKE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 CAMPUS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2896
Mailing Address - Country:US
Mailing Address - Phone:540-662-0306
Mailing Address - Fax:855-264-2066
Practice Address - Street 1:1880 AMHERST STREET
Practice Address - Street 2:SUITE 100 AND SUITE 200
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601
Practice Address - Country:US
Practice Address - Phone:540-662-0306
Practice Address - Fax:855-264-2066
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110-001320363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00067402OtherRAIL ROAD MEDICARE
P00656321OtherRAILROAD MEDICARE
P33620Medicare UPIN
P00067402OtherRAIL ROAD MEDICARE
VAMC10506Medicare PIN