Individual
LISA ANN RABOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
250 PARK ST, BOWLING GREEN, KY 42101-1760
(270) 393-1912
(270) 393-1913
Mailing address
825 2ND AVE, SUITE C6, BOWLING GREEN, KY 42101-1786
(270) 393-1912
(270) 393-1913
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
3004817
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000391703
BLUE CROSS
KY
05
—
74011578
—
KY
Enumeration date
04/17/2006
Last updated
09/08/2016
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