Provider Demographics
NPI:1104832088
Name:LASSITER, LISA GAYLE (RN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:GAYLE
Last Name:LASSITER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:4212 CARMICHAEL CT N
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-3621
Mailing Address - Country:US
Mailing Address - Phone:334-213-8803
Mailing Address - Fax:334-213-8815
Practice Address - Street 1:4212 CARMICHAEL CT N
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-3621
Practice Address - Country:US
Practice Address - Phone:334-213-8803
Practice Address - Fax:334-213-8815
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL1-043709363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner