Individual
MS. LISA CARROLL RADEBAUGH
Active
Individual
MS. LISA CARROLL RADEBAUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
R080294
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0092
CAREFIRST REGIONAL
MD
01
—
242566
KAISER
MD
01
—
53410801
BLUE SHIELD
MD
05
—
972003100
—
MD
Enumeration date
07/26/2006
Last updated
07/08/2007
Update your record
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