Healthcare Provider Details

I. General information

NPI: 1942736889
Provider Name (Legal Business Name): LISA ESTELLA MEIGHAN NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA WHITE-GREENE

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 10/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

743 SPRING ST NE
GAINESVILLE GA
30501-3715
US

IV. Provider business mailing address

PO BOX 658
GAINESVILLE GA
30503-0658
US

V. Phone/Fax

Practice location:
  • Phone: 770-535-3611
  • Fax: 770-535-7092
Mailing address:
  • Phone: 770-718-1122
  • Fax: 770-535-7445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberRN141217
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberRN141217
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: