Provider Demographics
NPI:1093062309
Name:CROWDER, LISA C
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:C
Last Name:CROWDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463 HARBIN DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37683-6047
Mailing Address - Country:US
Mailing Address - Phone:423-727-7123
Mailing Address - Fax:
Practice Address - Street 1:463 HARBIN DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN CITY
Practice Address - State:TN
Practice Address - Zip Code:37683-6047
Practice Address - Country:US
Practice Address - Phone:423-727-7123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist