Healthcare Provider Details

I. General information

NPI: 1275159055
Provider Name (Legal Business Name): LISA FRANCES UMPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2020
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

695 KINKAID RD
ANNAPOLIS MD
21402-1006
US

IV. Provider business mailing address

715 SAINT GEORGE BARBER RD
DAVIDSONVILLE MD
21035-1315
US

V. Phone/Fax

Practice location:
  • Phone: 410-293-2273
  • Fax: 410-293-1163
Mailing address:
  • Phone: 614-499-7226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LS0200X
TaxonomySchool Nurse Practitioner
License NumberRN.350995
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0032018
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: