Provider Demographics
NPI:1073858916
Name:LISA FOX
Entity Type:Organization
Organization Name:LISA FOX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN/FNP-C
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:MSN
Authorized Official - Phone:317-598-8874
Mailing Address - Street 1:7915 PRAIRIE VIEW DR
Mailing Address - Street 2:7915 PRAIRIE VIEW DR
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3493
Mailing Address - Country:US
Mailing Address - Phone:317-598-8874
Mailing Address - Fax:
Practice Address - Street 1:7915 PRAIRIE VIEW DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256
Practice Address - Country:US
Practice Address - Phone:317-626-1948
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28104395A282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital