1518281153 NPI number — LISA PODLESNY R.N.

Table of content: LISA PODLESNY R.N. (NPI 1518281153)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518281153 NPI number — LISA PODLESNY R.N.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PODLESNY
Provider First Name:
LISA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
R.N.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518281153
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
509 SUNLIGHT LN UNIT 6
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BERLIN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21811-1482
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-594-8242
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9730 HEALTHWAY DRIVE
Provider Second Line Business Practice Location Address:
WORCESTER COUNTY HEALTH DEPARTMENT - BERLIN HEALTH CT.
Provider Business Practice Location Address City Name:
BERLIN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-629-0164
Provider Business Practice Location Address Fax Number:
410-629-0185
Provider Enumeration Date:
03/25/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WC1500X , with the licence number:  R168158 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 705371101 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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