Provider Demographics
NPI:1871886697
Name:DEPPMEIER, LISA (PA-C)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:DEPPMEIER
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:2501 PARKERS LN
Mailing Address - Street 2:INOVA MT VERNON WOUND HEALING CENTER
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-3209
Mailing Address - Country:US
Mailing Address - Phone:703-664-8020
Mailing Address - Fax:703-664-7317
Practice Address - Street 1:2501 PARKERS LN
Practice Address - Street 2:INOVA MT VERNON WOUND HEALING CENTER
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3209
Practice Address - Country:US
Practice Address - Phone:703-664-8020
Practice Address - Fax:703-664-7317
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2016-12-04
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Provider Licenses
StateLicense IDTaxonomies
VA0110-003928363A00000X
MDC0004790363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant