Healthcare Provider Details

I. General information

NPI: 1427394873
Provider Name (Legal Business Name): LISA VAN MOL N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2012
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 PRESCOTT RD STE 110
ALEXANDRIA LA
71301-3917
US

IV. Provider business mailing address

201 4TH ST STE 4A
ALEXANDRIA LA
71301-8421
US

V. Phone/Fax

Practice location:
  • Phone: 318-448-4995
  • Fax: 318-561-4116
Mailing address:
  • Phone: 318-442-8698
  • Fax: 318-442-1358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberAP07118
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP07118
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: