Provider Demographics
NPI:1922621762
Name:SHOEMAKER, LISA MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:SHOEMAKER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:POPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:20095 GILBERT RD STE B
Mailing Address - Street 2:
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-2366
Mailing Address - Country:US
Mailing Address - Phone:315-921-3602
Mailing Address - Fax:231-592-1361
Practice Address - Street 1:20095 GILBERT RD STE B
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-2366
Practice Address - Country:US
Practice Address - Phone:315-921-3602
Practice Address - Fax:231-592-1361
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-27
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704248076363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily