Provider Demographics
NPI:1740479757
Name:CORWIN, LISA ANN (RN FNP-C)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANN
Last Name:CORWIN
Suffix:
Gender:F
Credentials:RN FNP-C
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Mailing Address - Street 1:901 PATIENTS FIRST DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-4700
Mailing Address - Country:US
Mailing Address - Phone:636-390-5503
Mailing Address - Fax:636-390-1760
Practice Address - Street 1:901 PATIENTS FIRST DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-4700
Practice Address - Country:US
Practice Address - Phone:636-390-5503
Practice Address - Fax:636-390-1760
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2004016343163W00000X
MO2010022930363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP01134560OtherRAILROAD MEDICARE
MO1740479757Medicaid
MO1740479757Medicaid