Provider Demographics
NPI:1255539904
Name:LISENBY, CROWELL ANTHONY SR
Entity type:Individual
Prefix:MR
First Name:CROWELL
Middle Name:ANTHONY
Last Name:LISENBY
Suffix:SR
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:TONY
Other - Middle Name:
Other - Last Name:LISENBY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNP
Mailing Address - Street 1:3464 S WATER MILL RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-1935
Mailing Address - Country:US
Mailing Address - Phone:334-277-7617
Mailing Address - Fax:334-272-9238
Practice Address - Street 1:101 COLISEUM BLVD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36109-2707
Practice Address - Country:US
Practice Address - Phone:334-279-7830
Practice Address - Fax:334-270-1647
Is Sole Proprietor?:No
Enumeration Date:2007-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-044909363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health