Healthcare Provider Details

I. General information

NPI: 1366535437
Provider Name (Legal Business Name): LISA ANN PALAZZOLO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7990 E US HIGHWAY 36
AVON IN
46123-7790
US

IV. Provider business mailing address

7990 E US HIGHWAY 36
AVON IN
46123-7790
US

V. Phone/Fax

Practice location:
  • Phone: 317-272-0242
  • Fax: 317-272-7219
Mailing address:
  • Phone: 317-272-0242
  • Fax: 317-272-7219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71001712
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71001712A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: