Provider Demographics
NPI:1538216999
Name:KWIATKOWSKI, LISA CARTER (RN, CRNA)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:CARTER
Last Name:KWIATKOWSKI
Suffix:
Gender:F
Credentials:RN, CRNA
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, CRNA
Mailing Address - Street 1:6424 15TH CT
Mailing Address - Street 2:UNIT A
Mailing Address - City:ELMENDORF AFB
Mailing Address - State:AK
Mailing Address - Zip Code:99506-2009
Mailing Address - Country:US
Mailing Address - Phone:907-753-4328
Mailing Address - Fax:
Practice Address - Street 1:4315 DIPLOMACY DR
Practice Address - Street 2:ALASKA NATIVE MEDICAL CENTER, DEPARTMENT OF ANESTHESIA
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5926
Practice Address - Country:US
Practice Address - Phone:907-729-2200
Practice Address - Fax:907-729-2222
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN43565163W00000X
CA485058163W00000X
MA168805163W00000X, 367500000X
TX655505163W00000X, 367500000X
NVCRNA000244367500000X
CA2317367500000X
AK28004163W00000X
AK331367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse