Individual
LISA A EVERITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
5900 LAKE WRIGHT DR, NORFOLK, VA 23502-1871
(757) 466-8683
(757) 466-0250
Mailing address
5900 LAKE WRIGHT DR, SUITE 300, NORFOLK, VA 23502-1871
(757) 213-5700
(757) 213-5701
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0110001877
VA
363AM0700X
Medical Physician Assistant
Primary
0110001877
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10019822P
OPTIMA
VA
05
—
1013916568
—
VA
Enumeration date
07/18/2005
Last updated
09/04/2008
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