Provider Demographics
NPI:1912180761
Name:PEOPLES, LISA A (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:PEOPLES
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 BROOKWOOD BLVD
Mailing Address - Street 2:SUITE #401
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6862
Mailing Address - Country:US
Mailing Address - Phone:205-870-0256
Mailing Address - Fax:205-870-7107
Practice Address - Street 1:513 BROOKWOOD BLVD
Practice Address - Street 2:SUITE #401
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6862
Practice Address - Country:US
Practice Address - Phone:205-870-0256
Practice Address - Fax:205-870-7107
Is Sole Proprietor?:No
Enumeration Date:2007-12-14
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1097941363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL129564Medicaid
AL129564Medicaid