Provider Demographics
NPI:1033545025
Name:NELSON, LISA A (RN)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:A
Last Name:NELSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-5204
Mailing Address - Country:US
Mailing Address - Phone:479-968-5048
Mailing Address - Fax:479-968-1498
Practice Address - Street 1:500 E 3RD ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-5204
Practice Address - Country:US
Practice Address - Phone:479-968-5048
Practice Address - Fax:479-968-1498
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR092478163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics