Provider Demographics
NPI:1912118506
Name:WASHINGTON, LISA SAMANTHA HOUSEN (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:SAMANTHA HOUSEN
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:SAMANTHA
Other - Last Name:HOUSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:2101 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-6660
Mailing Address - Fax:301-816-6308
Practice Address - Street 1:610 E DIAMOND AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-5321
Practice Address - Country:US
Practice Address - Phone:240-790-3334
Practice Address - Fax:301-820-7479
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR131339363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P69896Medicare UPIN
008539M92Medicare ID - Type Unspecified