MEDICARE: LISA SWEZEY NP

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	363LF0000X	Family Nurse Practitioner	0024177508	VA

General Provider Information

NPI Number	:	1518522960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA SWEZEY NP

Provider Business Mailing Address
First Line	:	316 MARY ANN DR APT 9
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24502-3795
Country	:	US
Telephone Number	:	618-803-8388
Fax Number	:

Provider Business Practice Location Address
First Line	:	1111 CORPORATE PARK DR STE D
Second Line	:
City	:	FOREST
State	:	VA
Zip	:	24551-2279
Country	:	US
Telephone Number	:	434-382-1125
Fax Number	:	434-544-2337

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

Provider Enumeration Date	:	05/01/2019
Last Update Date	:	06/25/2019

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