Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | R079598 | MD |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | R079598 | MD |
NPI | 1639192768 |
---|---|
Provider Name | Mrs. Lissa B Andrakakos |
First Address | Rockville, MD 20855-2634 |
Second Address | Rockville, MD 20855-2634 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 12/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S87390 | (02) |