Healthcare Provider Details

I. General information

NPI: 1780479956
Provider Name (Legal Business Name): LISA MCGEORGE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2025
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 HUNTER PL
WOODBRIDGE VA
22192-3943
US

IV. Provider business mailing address

2510 HUNTER PL
WOODBRIDGE VA
22192-3943
US

V. Phone/Fax

Practice location:
  • Phone: 571-316-1069
  • Fax:
Mailing address:
  • Phone: 571-316-1069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001257995
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: