Provider Demographics
NPI:1548071723
Name:MCKEAN, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:MCKEAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8130 BOONE BLVD STE 340
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2640
Mailing Address - Country:US
Mailing Address - Phone:571-221-0408
Mailing Address - Fax:
Practice Address - Street 1:8130 BOONE BLVD STE 340
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-2640
Practice Address - Country:US
Practice Address - Phone:703-734-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-16
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024192270363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily