Provider Demographics
NPI:1306930599
Name:SCOTT, LISA ANNE (NNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANNE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:A
Other - Last Name:FATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5855 BREMO RD STE 100
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1926
Mailing Address - Country:US
Mailing Address - Phone:804-282-8082
Mailing Address - Fax:317-278-9905
Practice Address - Street 1:5855 BREMO RD STE 100
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1926
Practice Address - Country:US
Practice Address - Phone:804-282-8082
Practice Address - Fax:317-278-9905
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001785363LN0000X
WAAP30005699363LN0000X
IN28077877363LN0000X
VA0017144265363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9630104Medicaid
IN200277520Medicaid
WAP19815Medicare UPIN
WAAB29334Medicare ID - Type Unspecified
WA9630104Medicaid