Provider Demographics
NPI:1649472267
Name:KERRIGAN, LISA LENE (RN)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:LENE
Last Name:KERRIGAN
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 1:824 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-3722
Mailing Address - Country:US
Mailing Address - Phone:906-228-5098
Mailing Address - Fax:
Practice Address - Street 1:824 HIGH ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-3722
Practice Address - Country:US
Practice Address - Phone:906-228-5098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704205381163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice