MEDICARE: MRS. LISA MARIE CHOATE LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	0002085033	VA

General Provider Information

NPI Number	:	1023767829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA MARIE CHOATE LPN

Provider Business Mailing Address
First Line	:	2100 ROANOKE ST STE 1
Second Line	:
City	:	CHRISTIANSBURG
State	:	VA
Zip	:	24073-2512
Country	:	US
Telephone Number	:	540-322-3040
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 ROANOKE ST STE 1
Second Line	:
City	:	CHRISTIANSBURG
State	:	VA
Zip	:	24073-2512
Country	:	US
Telephone Number	:	540-322-3040
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2022
Last Update Date	:	03/21/2022

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