Healthcare Provider Details

I. General information

NPI: 1104547579
Provider Name (Legal Business Name): LISA YEARY DNP- NA, CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2022
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 15TH AVE S
GREAT FALLS MT
59405-5240
US

IV. Provider business mailing address

18 MISSOURI BEND RD
GREAT FALLS MT
59404-6486
US

V. Phone/Fax

Practice location:
  • Phone: 706-833-4196
  • Fax:
Mailing address:
  • Phone: 706-833-4196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN-266290
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN-266291
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: