Provider Demographics
NPI:1548838022
Name:TRAVIS, LISA WILLIAMS
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:WILLIAMS
Last Name:TRAVIS
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 1:225 CITIZENS LN
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-3711
Mailing Address - Country:US
Mailing Address - Phone:757-633-5183
Mailing Address - Fax:
Practice Address - Street 1:11835 FISHING POINT DR
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2584
Practice Address - Country:US
Practice Address - Phone:757-243-1033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-11
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAA61765668OtherN/A