MEDICARE: LISA A KANAKRY BSN, RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WG0000X	General Practice Registered Nurse	2200402	FL

General Provider Information

NPI Number	:	1548570005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA A KANAKRY BSN, RN

Provider Business Mailing Address
First Line	:	15802 92ND WAY N
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33478-6937
Country	:	US
Telephone Number	:	561-512-0049
Fax Number	:

Provider Business Practice Location Address
First Line	:	5154 OKEECHOBEE BLVD
Second Line	:	SUITE 201
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33417-4501
Country	:	US
Telephone Number	:	561-683-1400
Fax Number	:	561-683-6773

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2010
Last Update Date	:	10/18/2010

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