Provider Demographics
NPI:1053635763
Name:CREWS, LISA TERRELL (NP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:TERRELL
Last Name:CREWS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:RENEE
Other - Last Name:TERRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:455 S MAIN ST STE 104
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-4354
Mailing Address - Country:US
Mailing Address - Phone:912-876-5644
Mailing Address - Fax:912-877-6341
Practice Address - Street 1:455 S MAIN ST STE 104
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-4354
Practice Address - Country:US
Practice Address - Phone:912-876-5644
Practice Address - Fax:912-877-6341
Is Sole Proprietor?:No
Enumeration Date:2010-03-24
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN113544363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAQ09024Medicare PIN