Provider Demographics
NPI:1679075543
Name:ALDRIDGE, LISA L
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:L
Last Name:ALDRIDGE
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 1:1025 PATIENCE DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63034-2058
Mailing Address - Country:US
Mailing Address - Phone:734-352-0377
Mailing Address - Fax:
Practice Address - Street 1:1025 PATIENCE DR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63034-2058
Practice Address - Country:US
Practice Address - Phone:734-352-0377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health