Provider Demographics
NPI:1912053216
Name:JABLON, LISA HARRIETT (RN, MS, CS)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:HARRIETT
Last Name:JABLON
Suffix:
Gender:F
Credentials:RN, MS, CS
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:SIMON
Other - Last Name:JABLON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, MS, CS
Mailing Address - Street 1:3717 LANAMER RD
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-1532
Mailing Address - Country:US
Mailing Address - Phone:410-922-8393
Mailing Address - Fax:
Practice Address - Street 1:615 FREDERICK RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228-4626
Practice Address - Country:US
Practice Address - Phone:410-887-0800
Practice Address - Fax:410-887-1050
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR036570163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool