Provider Demographics
NPI:1942993274
Name:TERRY, LISA RENE (RN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:RENE
Last Name:TERRY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:787 N DETROIT ST
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:IN
Mailing Address - Zip Code:46761-1111
Mailing Address - Country:US
Mailing Address - Phone:260-463-2172
Mailing Address - Fax:260-463-2180
Practice Address - Street 1:787 N DETROIT ST
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:IN
Practice Address - Zip Code:46761-1111
Practice Address - Country:US
Practice Address - Phone:260-463-2172
Practice Address - Fax:260-463-2180
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28119546C163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology