MEDICARE: MRS. LISA ZOBRIST WILSON APRN-C

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	1196987-6494	LA
2	363L00000X	Nurse Practitioner	AP06494	LA

General Provider Information

NPI Number	:	1073809018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA ZOBRIST WILSON APRN-C

Provider Business Mailing Address
First Line	:	10844 THISTLEWOOD DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70810
Country	:	US
Telephone Number	:	225-229-8589
Fax Number	:

Provider Business Practice Location Address
First Line	:	8980 MANCHAC RD
Second Line	:
City	:	SAINT GABRIEL
State	:	LA
Zip	:	70776-5811
Country	:	US
Telephone Number	:	225-229-8589
Fax Number	:

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

Provider Enumeration Date	:	06/28/2011
Last Update Date	:	05/30/2025

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