1720416894 NPI number — MS. LISA D BELL APRN

Table of content: MS. LISA D BELL APRN (NPI 1720416894)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720416894 NPI number — MS. LISA D BELL APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BELL
Provider First Name:
LISA
Provider Middle Name:
D
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720416894
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/03/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3103 BRECKENRIDGE LN STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40220-2798
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-495-5055
Provider Business Mailing Address Fax Number:
502-495-5057

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14 EVANS RD
Provider Second Line Business Practice Location Address:
CAMP ATTERBURY BUILDING
Provider Business Practice Location Address City Name:
EDINBURGH
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46124-5000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-526-1218
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/28/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  28172826A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)