Provider Demographics
NPI:1962540625
Name:RAPISARDI, LOIS JEAN LONG (CNM)
Entity type:Individual
Prefix:
First Name:LOIS
Middle Name:JEAN LONG
Last Name:RAPISARDI
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:LOIS
Other - Middle Name:JEAN
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:1000 MEDICAL CENTER BLVD
Mailing Address - Street 2:OB CLINIC
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-7694
Mailing Address - Country:US
Mailing Address - Phone:678-442-4616
Mailing Address - Fax:770-682-2251
Practice Address - Street 1:1000 MEDICAL CENTER BLVD
Practice Address - Street 2:OB CLINIC
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-7694
Practice Address - Country:US
Practice Address - Phone:678-442-4616
Practice Address - Fax:770-682-2251
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN092716367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA42BBBFRMedicare ID - Type Unspecified