Provider Demographics
NPI:1144665597
Name:FIELD, LISA ELLEN (CRNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ELLEN
Last Name:FIELD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ELLEN
Other - Last Name:MATEER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNP
Mailing Address - Street 1:22489 PRICE GRUBBS RD
Mailing Address - Street 2:
Mailing Address - City:ROBERTSDALE
Mailing Address - State:AL
Mailing Address - Zip Code:36567-2834
Mailing Address - Country:US
Mailing Address - Phone:251-609-4419
Mailing Address - Fax:
Practice Address - Street 1:200 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:GULF SHORES
Practice Address - State:AL
Practice Address - Zip Code:36542-3432
Practice Address - Country:US
Practice Address - Phone:251-968-7379
Practice Address - Fax:251-968-5960
Is Sole Proprietor?:No
Enumeration Date:2013-04-29
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-116868363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
9999OtherN/A