Provider Demographics
NPI:1538118120
Name:CRENSHAW, LISA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:CRENSHAW
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6025 WALNUT GROVE RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2131
Mailing Address - Country:US
Mailing Address - Phone:901-818-0300
Mailing Address - Fax:901-818-0458
Practice Address - Street 1:6025 WALNUT GROVE RD
Practice Address - Street 2:SUITE 111
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2131
Practice Address - Country:US
Practice Address - Phone:901-818-0300
Practice Address - Fax:901-818-0458
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11717363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3642137Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER