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General NPI Number Information
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NPI Number | 1225322712
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Entity Type | Individual
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Provider Name | NATHANIEL LISENBEE M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/02/2011
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Last Update Date | 01/16/2024
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Provider Practice Location Address
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Address Line | 6670 GREEN DR
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City | TRUSSVILLE
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State | AL
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Zip | 35173-2610
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Country | US
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Telephone | 205-537-3337
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Fax |
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Provider Business Mailing Address
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Address Line | 4929 NW 42ND RD
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City | GAINESVILLE
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State | FL
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Zip | 32606-6889
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | TRN16042
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MD.32245
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License Number State | AL
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