Healthcare Provider Details

I. General information

NPI: 1306930599
Provider Name (Legal Business Name): LISA ANNE SCOTT NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA A FATH

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 09/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5855 BREMO RD STE 100
RICHMOND VA
23226-1926
US

IV. Provider business mailing address

5855 BREMO RD STE 100
RICHMOND VA
23226-1926
US

V. Phone/Fax

Practice location:
  • Phone: 804-282-8082
  • Fax: 317-278-9905
Mailing address:
  • Phone: 804-282-8082
  • Fax: 317-278-9905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number71001785
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberAP30005699
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number28077877
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number0017144265
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: