Healthcare Provider Details

I. General information

NPI: 1003349556
Provider Name (Legal Business Name): LISA KAHANA-NAIPO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 02/28/2020
Certification Date: 02/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 GLENWOOD DR STE E786
CHATTANOOGA TN
37404-1192
US

IV. Provider business mailing address

725 GLENWOOD DR STE E786
CHATTANOOGA TN
37404-1192
US

V. Phone/Fax

Practice location:
  • Phone: 423-682-8150
  • Fax: 423-682-8151
Mailing address:
  • Phone: 423-682-8150
  • Fax: 423-682-8151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number22512
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: