Healthcare Provider Details

I. General information

NPI: 1518522960
Provider Name (Legal Business Name): LISA SWEZEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2019
Last Update Date: 06/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 CORPORATE PARK DR STE D
FOREST VA
24551-2279
US

IV. Provider business mailing address

316 MARY ANN DR APT 9
LYNCHBURG VA
24502-3795
US

V. Phone/Fax

Practice location:
  • Phone: 434-382-1125
  • Fax: 434-544-2337
Mailing address:
  • Phone: 618-803-8388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024177508
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: