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General NPI Number Information
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NPI Number | 1780114850
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Entity Type | Individual
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Provider Name | LISA MARIE O'DRISCOLL CRNA
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Gender | Female
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Dates
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Enumeration Date | 06/12/2017
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Last Update Date | 07/21/2023
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Provider Practice Location Address
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Address Line | 1 BOONE RD
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City | BREMERTON
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State | WA
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Zip | 98312-1894
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Country | US
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Telephone | 360-475-4232
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Fax |
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Provider Business Mailing Address
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Address Line | 1 BOONE RD
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City | BREMERTON
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State | WA
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Zip | 98312-1894
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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 | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number | RN56252
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | RN56252
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | AP60849421
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License Number State | WA
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