Provider Demographics
NPI:1003705765
Name:HARDING, LISA NICOLE (PMHNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:NICOLE
Last Name:HARDING
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:NICOLE
Other - Last Name:WILLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP
Mailing Address - Street 1:89 CHARTER GATE DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22406-8206
Mailing Address - Country:US
Mailing Address - Phone:801-600-1905
Mailing Address - Fax:
Practice Address - Street 1:89 CHARTER GATE DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22406-8206
Practice Address - Country:US
Practice Address - Phone:801-600-1905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12048911-3102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse