Provider Demographics
NPI:1215943972
Name:MCBRAYER, LISA LYNN (CRNA)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:LYNN
Last Name:MCBRAYER
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 1:968 SUNRISE BEACH DR
Mailing Address - Street 2:
Mailing Address - City:AMERY
Mailing Address - State:WI
Mailing Address - Zip Code:54001-4829
Mailing Address - Country:US
Mailing Address - Phone:715-268-6141
Mailing Address - Fax:
Practice Address - Street 1:2302 HIGHWAY 46
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:WI
Practice Address - Zip Code:54007-7501
Practice Address - Country:US
Practice Address - Phone:715-269-5530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI044983367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43397200Medicaid
MNR 113428-9OtherRN LICENSE