Healthcare Provider Details

I. General information

NPI: 1912362203
Provider Name (Legal Business Name): LISA JUANITA WASHINGTON BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2015
Last Update Date: 10/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6309 HALLWOOD DR
VERONA PA
15147-2526
US

IV. Provider business mailing address

6309 HALLWOOD DR
VERONA PA
15147-2526
US

V. Phone/Fax

Practice location:
  • Phone: 412-377-9102
  • Fax:
Mailing address:
  • Phone: 412-377-9102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN620599
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN620599
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN620599
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License NumberRN620599
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License NumberRN620599
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code163WX1500X
TaxonomyOstomy Care Registered Nurse
License NumberRN620599
License Number StatePA
# 7
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License NumberRN620599
License Number StatePA
# 8
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN620599
License Number StatePA
# 9
Primary TaxonomyN
Taxonomy Code163WP0218X
TaxonomyPediatric Oncology Registered Nurse
License NumberRN620599
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: