Individual
LISA DAMERON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0001217082
VA
363LF0000X
Family Nurse Practitioner
Primary
0024170321
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1952648123
—
VA
01
—
261083931
TAX ID
—
01
—
DN2980
GROUP PTAN
—
01
—
VV8951A
PTAN
VA
Enumeration date
01/08/2013
Last updated
08/26/2014
Update your record
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