Provider Demographics
NPI:1871742064
Name:BROCK, LISA RENE (RN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:RENE
Last Name:BROCK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1115 BOULDERS PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4067
Mailing Address - Country:US
Mailing Address - Phone:804-560-5595
Mailing Address - Fax:804-560-9029
Practice Address - Street 1:1400 JOHNSTON WILLIS DR
Practice Address - Street 2:STE A
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-4765
Practice Address - Country:US
Practice Address - Phone:804-379-8088
Practice Address - Fax:804-794-6067
Is Sole Proprietor?:No
Enumeration Date:2008-09-12
Last Update Date:2013-01-31
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Provider Licenses
StateLicense IDTaxonomies
VA0001106374163WX0800X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WX0800XNursing Service ProvidersRegistered NurseOrthopedic