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General NPI Number Information
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NPI Number | 1972390755
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Entity Type | Individual
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Provider Name | LISA NICHOLAS CRNP
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Gender | Female
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Dates
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Enumeration Date | 04/23/2025
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Last Update Date | 08/08/2025
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Provider Practice Location Address
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Address Line | 18101 PRINCE PHILIP DR
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City | OLNEY
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State | MD
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Zip | 20832-1514
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Country | US
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Telephone | 301-774-8882
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Fax |
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Provider Business Mailing Address
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Address Line | 7986 LAKECREST DR
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City | GREENBELT
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State | MD
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Zip | 20770-3306
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R239037
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 163WM0705X
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Taxonomy Name | Medical-Surgical Registered Nurse
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License Number | R239037
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License Number State | MD
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