1326000910 NPI number — MS. LISA T. KRIEG MSN,RN,FNP-BC,BC-ADM

Table of content: MS. LISA T. KRIEG MSN,RN,FNP-BC,BC-ADM (NPI 1326000910)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326000910 NPI number — MS. LISA T. KRIEG MSN,RN,FNP-BC,BC-ADM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KRIEG
Provider First Name:
LISA
Provider Middle Name:
T.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSN,RN,FNP-BC,BC-ADM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TANNENBAUM
Provider Other First Name:
LISA
Provider Other Middle Name:
B.
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1326000910
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
413 STUART CIR
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23220-3741
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-545-1920
Provider Business Mailing Address Fax Number:
804-545-1935

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
413 STUART CIR
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23220-3741
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-545-1920
Provider Business Practice Location Address Fax Number:
804-545-1935
Provider Enumeration Date:
04/06/2006

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: 363LF0000X , with the licence number:  0024164950 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 015455R79 . This is a "MC IDENTIFIER PIN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com