Provider Demographics
NPI:1215605050
Name:MACRI, LISA NICOLE
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:NICOLE
Last Name:MACRI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 JEANNE ST
Mailing Address - Street 2:
Mailing Address - City:EUNICE
Mailing Address - State:LA
Mailing Address - Zip Code:70535-4208
Mailing Address - Country:US
Mailing Address - Phone:337-706-2299
Mailing Address - Fax:
Practice Address - Street 1:161 JEANNE ST
Practice Address - Street 2:
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535-4208
Practice Address - Country:US
Practice Address - Phone:337-706-2299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-04
Last Update Date:2021-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)