Healthcare Provider Details

I. General information

NPI: 1740245786
Provider Name (Legal Business Name): LISA C RADER A-NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 02/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 SELMA DR
WINCHESTER VA
22601
US

IV. Provider business mailing address

104 SELMA DR
WINCHESTER VA
22601
US

V. Phone/Fax

Practice location:
  • Phone: 540-678-2800
  • Fax: 540-678-2859
Mailing address:
  • Phone: 540-678-2800
  • Fax: 540-678-2859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNP0024166267
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: