Basic Information
| Provider Information | |||||||||
| NPI: | 1982670303 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GITTLEMAN | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | MELONY | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2820 S ABINGDON ST APT B2 | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 222061361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8582292473 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2120 WASHINGTON BLVD | ||||||||
| Address2: | SEQUOIA 3/3RD FLOOR | ||||||||
| City: | ARLINGTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035355568 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2006 | ||||||||
| LastUpdateDate: | 06/11/2019 | ||||||||
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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 | 363LF0000X | 0024173782 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.