Healthcare Provider Details

I. General information

NPI: 1043244189
Provider Name (Legal Business Name): LISA JAN SEAY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 08/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6554 HOUNDS RUN N
MOBILE AL
36608-5407
US

IV. Provider business mailing address

6554 HOUNDS RUN N
MOBILE AL
36608-5407
US

V. Phone/Fax

Practice location:
  • Phone: 502-216-2731
  • Fax: 502-216-2731
Mailing address:
  • Phone: 502-216-2731
  • Fax: 502-216-2731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number71002078
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: