Provider Demographics
NPI:1548984248
Name:MAY, LISA RUTH (FNP-BC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:RUTH
Last Name:MAY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11648 N ALCORN RD
Mailing Address - Street 2:
Mailing Address - City:CANAAN
Mailing Address - State:IN
Mailing Address - Zip Code:47224-9700
Mailing Address - Country:US
Mailing Address - Phone:812-701-0345
Mailing Address - Fax:
Practice Address - Street 1:202 E MAPLE ST
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3420
Practice Address - Country:US
Practice Address - Phone:317-220-6383
Practice Address - Fax:317-458-1794
Is Sole Proprietor?:No
Enumeration Date:2022-09-27
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71013121A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily