Healthcare Provider Details

I. General information

NPI: 1912053216
Provider Name (Legal Business Name): LISA HARRIETT JABLON RN, MS, CS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LISA SIMON JABLON RN, MS, CS

II. Dates (important events)

Enumeration Date: 01/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 FREDERICK RD
BALTIMORE MD
21228-4626
US

IV. Provider business mailing address

3717 LANAMER RD
RANDALLSTOWN MD
21133-1532
US

V. Phone/Fax

Practice location:
  • Phone: 410-887-0800
  • Fax: 410-887-1050
Mailing address:
  • Phone: 410-922-8393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR036570
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: