MEDICARE: MRS. LISA MARIE BONDS

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	347C00000X	Private Vehicle		AL
2	172A00000X	Driver

General Provider Information

NPI Number	:	1174385009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA MARIE BONDS

Provider Business Mailing Address
First Line	:	3844 41ST AVE N
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35217-3801
Country	:	US
Telephone Number	:	205-999-5572
Fax Number	:

Provider Business Practice Location Address
First Line	:	3844 41ST AVE N
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35217-3801
Country	:	US
Telephone Number	:	205-999-5572
Fax Number	:

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

Provider Enumeration Date	:	01/25/2024
Last Update Date	:	01/25/2024

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