Individual provider Active NPI

Lisa M Davis, NNP-BC

  • Nurse Practitioner
  • Wilmington, DE
National Provider Identifier
1952660144
Registry record updated Oct 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
L1-0033857 Issued in DE
Practice address
1600 Rockland Rd
Wilmington, DE 19803
Phone
(302) 651-4200
Fax
(302) 651-4945
NPI assigned
May 9, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Neonatal Nurse Practitioner 363LN0005X SP012019 PA
Nurse Practitioner 363L00000X L1-0033857 DE Primary

Addresses

Primary practice location

1600 Rockland Rd
Wilmington, DE 19803

Mailing address

PO Box 191
Rockland, DE 19732-0191
Phone (302) 651-4200

Other practice location 1

34th Street and Civic Center Boulevard
Philadelphia, PA 19104-4399
Phone (215) 776-7123

Other practice location 2

34th Street and Civic Center Boulevard
Philadelphia, PA 19104-4399
Phone (215) 776-7123

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DE2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20131029001648 MD Practitioner - Nurse Practitioner 5395970313 Reassigns benefits to 1 organization
I20200228000390 DE Practitioner - Nurse Practitioner 5395970313 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
L1-0033857DEMDNurse Practitioner
SP012019PAMDCritical Care Neonatal Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The Nemours Foundation CurrentSince Jan 15, 2020 Accepting new patients
The Nemours Foundation CurrentSince Jan 15, 2020 Accepting new patients
The Nemours Foundation Past Accepting new patients

Locations

1600 Rockland Rd
Wilmington, DE 19803

701 N Clayton St
Ste 400
Wilmington, DE 19805
Phone (302) 421-9700

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1336521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570579200000",
    "number": "1952660144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 191",
            "city": "ROCKLAND",
            "state": "DE",
            "postal_code": "197320191",
            "telephone_number": "302-651-4200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 ROCKLAND RD",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "19803",
            "telephone_number": "302-651-4200",
            "fax_number": "302-651-4945"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "34th Street and Civic Center Boulevard",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191044399",
            "country_code": "US",
            "telephone_number": "215-776-7123",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "34th Street and Civic Center Boulevard",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191044399",
            "country_code": "US",
            "telephone_number": "215-776-7123",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "LISA",
        "middle_name": "M",
        "credential": "NNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-05-09",
        "last_updated": "2019-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LN0005X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Neonatal, Critical Care",
            "state": "PA",
            "license": "SP012019",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "DE",
            "license": "L1-0033857",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, DE

Sources for this page

Verify at the official NPI Registry.