Provider Demographics
NPI:1518528215
Name:ALLENSWORTH, LISA L (LPN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:L
Last Name:ALLENSWORTH
Suffix:
Gender:F
Credentials:LPN
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 214
Mailing Address - Street 2:
Mailing Address - City:SAINT MARIE
Mailing Address - State:MT
Mailing Address - Zip Code:59231-0214
Mailing Address - Country:US
Mailing Address - Phone:314-799-8498
Mailing Address - Fax:314-480-7061
Practice Address - Street 1:326 ASH STREET
Practice Address - Street 2:UNIT A
Practice Address - City:ST. MARIE
Practice Address - State:MT
Practice Address - Zip Code:59231-5923
Practice Address - Country:US
Practice Address - Phone:406-524-3117
Practice Address - Fax:314-480-7061
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT129836164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse