Provider Demographics
NPI:1477234532
Name:COLE MARTIN, LISA L
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:L
Last Name:COLE MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:L
Other - Last Name:COLE MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EDD
Mailing Address - Street 1:8326 KELWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-4803
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:118 VILLAGE DR STE A
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-5228
Practice Address - Country:US
Practice Address - Phone:504-482-2600
Practice Address - Fax:504-482-2644
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator