Provider Demographics
NPI:1043205776
Name:NEWMAN, LISA R (CRNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:R
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2701 MOODY PARKWAY
Mailing Address - Street 2:
Mailing Address - City:MOODY
Mailing Address - State:AL
Mailing Address - Zip Code:35004
Mailing Address - Country:US
Mailing Address - Phone:205-640-1100
Mailing Address - Fax:205-640-4189
Practice Address - Street 1:2701 MOODY PARKWAY
Practice Address - Street 2:
Practice Address - City:MOODY
Practice Address - State:AL
Practice Address - Zip Code:35004
Practice Address - Country:US
Practice Address - Phone:205-640-1100
Practice Address - Fax:205-640-4189
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00023595363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
S54216Medicare UPIN