Provider Demographics
NPI:1306492913
Name:BEARMAN, LISA MICHELE (CRNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MICHELE
Last Name:BEARMAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8924 PHILADELPHIA RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-4313
Mailing Address - Country:US
Mailing Address - Phone:410-790-9477
Mailing Address - Fax:
Practice Address - Street 1:9103 FRANKLIN SQUARE DR STE 1800
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-3938
Practice Address - Country:US
Practice Address - Phone:443-777-2467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-11
Last Update Date:2019-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR169032363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care