Provider Demographics
NPI:1346495355
Name:BURY, LISA C (FNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:C
Last Name:BURY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:UNDERWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:535 S BURDICK ST STE 160
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-6113
Mailing Address - Country:US
Mailing Address - Phone:269-388-5864
Mailing Address - Fax:269-388-5221
Practice Address - Street 1:535 S BURDICK ST STE 160
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-6113
Practice Address - Country:US
Practice Address - Phone:269-388-5864
Practice Address - Fax:269-388-5221
Is Sole Proprietor?:No
Enumeration Date:2008-11-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704241397363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00909189OtherRAILROAD MEDICARE
P00909189OtherRAILROAD MEDICARE