Healthcare Provider Details

I. General information

NPI: 1215923768
Provider Name (Legal Business Name): LISA M BELL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 616
EDWARDSVILLE IL
62025-0616
US

IV. Provider business mailing address

PO BOX 616
EDWARDSVILLE IL
62025-0616
US

V. Phone/Fax

Practice location:
  • Phone: 833-749-8324
  • Fax: 214-301-0649
Mailing address:
  • Phone: 833-749-8324
  • Fax: 214-301-0649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209-004429
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041-218169
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: