Provider Demographics
NPI:1962805028
Name:CRANE, LISA (NP-C)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:CRANE
Suffix:
Gender:
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13451 STONE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79124-4681
Mailing Address - Country:US
Mailing Address - Phone:575-708-1438
Mailing Address - Fax:
Practice Address - Street 1:3841 MIDWAY PL NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-5814
Practice Address - Country:US
Practice Address - Phone:505-429-1792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-03
Last Update Date:2025-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-02650207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO86231871Medicaid
CO063874Medicare UPIN