Healthcare Provider Details

I. General information

NPI: 1700960226
Provider Name (Legal Business Name): LISA M SMITH N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 NATIONWIDE DR SUITE A
LYNCHBURG VA
24502-4272
US

IV. Provider business mailing address

121 NATIONWIDE DR SUITE A
LYNCHBURG VA
24502-4272
US

V. Phone/Fax

Practice location:
  • Phone: 434-384-1862
  • Fax: 434-384-7704
Mailing address:
  • Phone: 434-384-1862
  • Fax: 434-384-7704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024120815
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: