Healthcare Provider Details

I. General information

NPI: 1043205776
Provider Name (Legal Business Name): LISA R NEWMAN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: LISA ROBINSON

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 MOODY PARKWAY
MOODY AL
35004
US

IV. Provider business mailing address

2701 MOODY PARKWAY
MOODY AL
35004
US

V. Phone/Fax

Practice location:
  • Phone: 205-640-1100
  • Fax: 205-640-4189
Mailing address:
  • Phone: 205-640-1100
  • Fax: 205-640-4189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number00023595
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: