Provider Demographics
NPI:1699883603
Name:CRAFT, LISA D (NP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:D
Last Name:CRAFT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-4206
Mailing Address - Country:US
Mailing Address - Phone:504-988-3002
Mailing Address - Fax:504-988-4050
Practice Address - Street 1:711 N BROAD ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-4206
Practice Address - Country:US
Practice Address - Phone:504-988-3002
Practice Address - Fax:504-988-4050
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP033420363LC1500X
LA033420363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00125337Medicaid
LA1554367Medicaid
AL891017616Medicaid
LA5X847D867Medicare PIN
500026149Medicare PIN
S79340Medicare UPIN
LA1554367Medicaid
AL891017616Medicaid