Provider Demographics
NPI:1164645669
Name:ANDERSON, LISA (RNFA)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RNFA
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 86154
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70879-6154
Mailing Address - Country:US
Mailing Address - Phone:888-322-6432
Mailing Address - Fax:888-329-6432
Practice Address - Street 1:10280 PARKVIEW DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-4544
Practice Address - Country:US
Practice Address - Phone:888-322-6432
Practice Address - Fax:888-329-6432
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN054101163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant