Provider Demographics
NPI:1780842062
Name:CRANWELL-BRUCE, LISA ANN (FNP-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:CRANWELL-BRUCE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5775 GLENRIDGE DR NE # B
Mailing Address - Street 2:SUITE 145
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5380
Mailing Address - Country:US
Mailing Address - Phone:404-659-5909
Mailing Address - Fax:770-399-9449
Practice Address - Street 1:5775 GLENRIDGE DR NE # B
Practice Address - Street 2:SUITE 145
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5380
Practice Address - Country:US
Practice Address - Phone:404-659-5909
Practice Address - Fax:770-399-9449
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN080107363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner