Healthcare Provider Details

I. General information

NPI: 1144232851
Provider Name (Legal Business Name): LISA ANN RUBENBERG CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 06/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6521 LAS FLORES DR
BOCA RATON FL
33433-2366
US

IV. Provider business mailing address

6521 LAS FLORES DR
BOCA RATON FL
33433-2366
US

V. Phone/Fax

Practice location:
  • Phone: 561-573-6477
  • Fax:
Mailing address:
  • Phone: 561-573-6477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9173478
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: