Provider Demographics
NPI:1982060497
Name:JOHNSON, LISA (FNP-C, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 SANGAMORE RD STE N100
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20816-2558
Mailing Address - Country:US
Mailing Address - Phone:301-985-2898
Mailing Address - Fax:301-985-2890
Practice Address - Street 1:4701 SANGAMORE RD STE N100
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20816-2558
Practice Address - Country:US
Practice Address - Phone:301-985-2898
Practice Address - Fax:301-985-9820
Is Sole Proprietor?:No
Enumeration Date:2016-01-13
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR185905163W00000X, 363LF0000X, 363LP0808X
DELG-0001237363LF0000X
DEL8-0010330363LP0808X
DCRN1015708363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily