Individual
LISA BERRY LASATER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1400 US HIGHWAY 61, FESTUS, MO 63028-4100
(636) 933-1000
Mailing address
PO BOX 350, CRYSTAL CITY, MO 63019-0350
(636) 933-1000
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
072604
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
430687077008
TRICARE
MO
05
—
917183808
—
MO
01
—
P00356067
RR MEDICARE
MO
Enumeration date
08/01/2006
Last updated
05/02/2008
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