Provider Demographics
NPI:1124172762
Name:FITCH, LISA R (RNC, WHNP)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:R
Last Name:FITCH
Suffix:
Gender:F
Credentials:RNC, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 NE 54TH ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64118-4338
Mailing Address - Country:US
Mailing Address - Phone:816-455-7400
Mailing Address - Fax:816-455-7404
Practice Address - Street 1:200 NE 54TH ST
Practice Address - Street 2:SUITE 111
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64118-4338
Practice Address - Country:US
Practice Address - Phone:816-455-7400
Practice Address - Fax:816-455-7404
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO099746363LW0102X
MORN099746363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO099746OtherSTATE LICENSE NUMBER