MEDICARE: LISA CASTOR NP

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	363L00000X	Nurse Practitioner	71001627A	IN

General Provider Information

NPI Number	:	1902826084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA CASTOR NP

Provider Business Mailing Address
First Line	:	1427 W 86TH ST
Second Line	:	SUITE 152
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-2103
Country	:	US
Telephone Number	:	317-771-1140
Fax Number	:	317-780-5532

Provider Business Practice Location Address
First Line	:	1427 W 86TH ST
Second Line	:	SUITE 152
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-2103
Country	:	US
Telephone Number	:	317-771-1140
Fax Number	:	317-780-5532

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	01/24/2013

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Directions to “ LISA CASTOR NP” Practice Location

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