Healthcare Provider Details

I. General information

NPI: 1699883603
Provider Name (Legal Business Name): LISA D CRAFT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 N BROAD ST
NEW ORLEANS LA
70119-4206
US

IV. Provider business mailing address

711 N BROAD ST
NEW ORLEANS LA
70119-4206
US

V. Phone/Fax

Practice location:
  • Phone: 504-988-3002
  • Fax: 504-988-4050
Mailing address:
  • Phone: 504-988-3002
  • Fax: 504-988-4050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License NumberAP033420
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number033420
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: