Provider Demographics
NPI:1215923768
Name:BELL, LISA M (CRNA)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:M
Last Name:BELL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 616
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-0616
Mailing Address - Country:US
Mailing Address - Phone:833-749-8324
Mailing Address - Fax:214-301-0649
Practice Address - Street 1:PO BOX 616
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-0616
Practice Address - Country:US
Practice Address - Phone:833-749-8324
Practice Address - Fax:214-301-0649
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-004429367500000X
IL041-218169163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse