Healthcare Provider Details

I. General information

NPI: 1912078668
Provider Name (Legal Business Name): LISA MARIE CROWE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA MARIE SMITH CRNP

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 HOSPITAL DR
NORTHPORT AL
35476-3360
US

IV. Provider business mailing address

2330 UNIVERSITY BLVD SUITE 501
TUSCALOOSA AL
35401-1599
US

V. Phone/Fax

Practice location:
  • Phone: 205-366-3334
  • Fax: 205-344-9031
Mailing address:
  • Phone: 205-366-3334
  • Fax: 205-344-9031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-065227
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: