Provider Demographics
NPI:1891831814
Name:CROW DEMARS, LISA JEANNINE (NP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:JEANNINE
Last Name:CROW DEMARS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:JEANNINE
Other - Last Name:CROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:304 PINEMOUNT DR
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-1237
Mailing Address - Country:US
Mailing Address - Phone:404-290-7442
Mailing Address - Fax:
Practice Address - Street 1:304 PINEMOUNT DR
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-1237
Practice Address - Country:US
Practice Address - Phone:404-290-7442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN107984NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA363LF0000XOtherFAMILY NURSE PRACTITIONER