Provider Demographics
NPI:1144269168
Name:PAZDUR, LISA M (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:PAZDUR
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:2150 GETTLER ST STE 305
Practice Address - Street 2:
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-2381
Practice Address - Country:US
Practice Address - Phone:219-864-2630
Practice Address - Fax:219-864-2638
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000717363L00000X
IN71000717A363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200286330Medicaid
IN200286330AMedicaid
IN200286330AMedicaid
IN499500AAMedicare PIN
INP 09949Medicare UPIN