Healthcare Provider Details

I. General information

NPI: 1740218791
Provider Name (Legal Business Name): LISA M BENNETT CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA M RIEDEL

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 LAKE LANSING RD
LANSING MI
48912-3742
US

IV. Provider business mailing address

1701 SOUTH BLVD E STE 300
ROCHESTER HILLS MI
48307-6120
US

V. Phone/Fax

Practice location:
  • Phone: 517-332-1200
  • Fax: 517-351-7122
Mailing address:
  • Phone: 248-884-9710
  • Fax: 248-884-9711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704205789
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN-324508
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR0134240
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: