=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548984248
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA RUTH MAY FNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2022
-----------------------------------------------------
Last Update Date | 08/21/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 202 E MAPLE ST
-----------------------------------------------------
City | JEFFERSONVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47130-3420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-220-6383
-----------------------------------------------------
Fax | 317-458-1794
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11648 N ALCORN RD
-----------------------------------------------------
City | CANAAN
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47224-9700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-701-0345
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 71013121A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------