Individual
LISA DAWN FETTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
150 KINGSLEY LN, NORFOLK, VA 23505-4602
(757) 484-5900
(757) 483-3371
Mailing address
150 KINGSLEY LN, NORFOLK, VA 23505-4602
(757) 484-5900
(757) 483-3371
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110004274
VA
Other
Enumeration date
10/24/2013
Last updated
11/06/2013
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