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General NPI Number Information
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NPI Number | 1861055907
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Entity Type | Individual
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Provider Name | LISA A GOLDSTEIN CNM
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Gender | Female
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Dates
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Enumeration Date | 04/15/2019
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Last Update Date | 09/11/2024
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Provider Practice Location Address
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Address Line | 2955 IVY RD STE 104
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22903-9353
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Country | US
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Telephone | 434-243-4720
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Fax | 434-243-4733
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Provider Business Mailing Address
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Address Line | PO BOX 749112
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City | ATLANTA
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State | GA
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Zip | 30374-9112
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 0024166206
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 0024166206
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License Number State | VA
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