MEDICARE: LISA R NEWMAN CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	00023595	AL

General Provider Information

NPI Number	:	1043205776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA R NEWMAN CRNP

Provider Business Mailing Address
First Line	:	2701 MOODY PARKWAY
Second Line	:
City	:	MOODY
State	:	AL
Zip	:	35004
Country	:	US
Telephone Number	:	205-640-1100
Fax Number	:	205-640-4189

Provider Business Practice Location Address
First Line	:	2701 MOODY PARKWAY
Second Line	:
City	:	MOODY
State	:	AL
Zip	:	35004
Country	:	US
Telephone Number	:	205-640-1100
Fax Number	:	205-640-4189

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	07/08/2007

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