Provider Demographics
NPI:1255845574
Name:STEELE, LISA WEINMANN
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:WEINMANN
Last Name:STEELE
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:HEALTH PARTNERS OF GOODWATER
Mailing Address - Street 2:21342 AL HWY. 9
Mailing Address - City:GOODWATER
Mailing Address - State:AL
Mailing Address - Zip Code:35072
Mailing Address - Country:US
Mailing Address - Phone:256-743-1300
Mailing Address - Fax:256-743-1301
Practice Address - Street 1:HEALTH PARTNERS OF GOODWATER
Practice Address - Street 2:21342 AL HWY. 9
Practice Address - City:GOODWATER
Practice Address - State:AL
Practice Address - Zip Code:35072
Practice Address - Country:US
Practice Address - Phone:256-743-1300
Practice Address - Fax:256-743-1301
Is Sole Proprietor?:No
Enumeration Date:2017-11-22
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2017009840363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL512-2256OtherBLUE CROSS BLUE SHIELD OF ALABAMA