Healthcare Provider Details

I. General information

NPI: 1386647899
Provider Name (Legal Business Name): LISA BROOKS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2005
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 MAIN ST
FRANKLINTON LA
70438-3688
US

IV. Provider business mailing address

PO BOX 3087 CREDENTIALING
HAMMOND LA
70404-3087
US

V. Phone/Fax

Practice location:
  • Phone: 985-839-4431
  • Fax: 985-839-4431
Mailing address:
  • Phone: 985-230-1682
  • Fax: 985-230-6652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN033495
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP01780
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: