MEDICARE: MISS ANNA LISA LICUD ACNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	NP1003124	DC

General Provider Information

NPI Number	:	1427197888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ANNA LISA LICUD ACNP

Provider Business Mailing Address
First Line	:	9004 TEDDY RAE CT
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22152-2644
Country	:	US
Telephone Number	:	571-594-3405
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 IRVING ST., NW
Second Line	:	WHC SURGICAL CRITICAL CARE SERVICE SUITE 4B-42
City	:	WASHINGTON
State	:	DC
Zip	:	20010-2975
Country	:	US
Telephone Number	:	202-877-7259
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	08/09/2024

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