Provider Demographics
NPI:1548706807
Name:CAFFEE, LISA (NP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:CAFFEE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LESA
Other - Middle Name:ANN
Other - Last Name:CAFFEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:221 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-2653
Mailing Address - Country:US
Mailing Address - Phone:248-398-6459
Mailing Address - Fax:248-398-4770
Practice Address - Street 1:221 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-2653
Practice Address - Country:US
Practice Address - Phone:248-398-6459
Practice Address - Fax:248-398-4770
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704323777363L00000X
OH020228363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner