Provider Demographics
NPI:1952787400
Name:ISON, LERA SALVATIERRA (CRNP- F)
Entity Type:Individual
Prefix:MRS
First Name:LERA
Middle Name:SALVATIERRA
Last Name:ISON
Suffix:
Gender:F
Credentials:CRNP- F
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1539 BLAKES LEGACY DR
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-1946
Mailing Address - Country:US
Mailing Address - Phone:817-319-6878
Mailing Address - Fax:
Practice Address - Street 1:18111 PRINCE PHILIP DR
Practice Address - Street 2:STE 300
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1513
Practice Address - Country:US
Practice Address - Phone:301-774-2991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-07
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR181497363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily