MEDICARE: LISA BASILE RNFA

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	163W00000X	Registered Nurse	RN1458162	FL

General Provider Information

NPI Number	:	1245252360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA BASILE RNFA

Provider Business Mailing Address
First Line	:	3401 PGA BLVD
Second Line	:	SUITE 500
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-2823
Country	:	US
Telephone Number	:	561-694-7776
Fax Number	:	561-776-8486

Provider Business Practice Location Address
First Line	:	3401 PGA BLVD
Second Line	:	SUITE 500
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-2823
Country	:	US
Telephone Number	:	561-694-7776
Fax Number	:	561-776-8486

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	07/08/2007

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