Healthcare Provider Details

I. General information

NPI: 1457264707
Provider Name (Legal Business Name): LISA M MEMMERS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13017 HOOSIER CT
HAGERSTOWN MD
21740-3580
US

IV. Provider business mailing address

13017 HOOSIER CT
HAGERSTOWN MD
21740-3580
US

V. Phone/Fax

Practice location:
  • Phone: 330-906-3331
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN727274
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR271973
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: