Healthcare Provider Details

I. General information

NPI: 1013974252
Provider Name (Legal Business Name): LISA SUZANNE WINTERS CNNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 E 3RD ST
CHATTANOOGA TN
37403-2103
US

IV. Provider business mailing address

9601 SHADOW BEND CIR
CHATTANOOGA TN
37421-5383
US

V. Phone/Fax

Practice location:
  • Phone: 423-778-6170
  • Fax:
Mailing address:
  • Phone: 423-899-1890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number10796
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: