Basic Information
| Provider Information | |||||||||
| NPI: | 1336185735 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LUGENT | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12917 ASPIRE CT | ||||||||
| Address2: | |||||||||
| City: | BRISTOW | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201363123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5712615095 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8700 SUDLEY ROAD | ||||||||
| Address2: | PRINCE WILLIAM HOSPITAL | ||||||||
| City: | MANASSAS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 20110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7033698337 | ||||||||
| FaxNumber: | 7033698868 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2006 | ||||||||
| LastUpdateDate: | 01/28/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 0110001986 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.