Individual
LISA LYNN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
1054427
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000652451B
—
GA
05
—
051515740
—
AL
05
—
301239500
—
FL
01
—
51515740
BLUE CROSS BLUE SHIELD
AL
01
—
P00078968
RR MEDICARE
—
Enumeration date
03/31/2006
Last updated
07/25/2011
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