Basic Information
| Provider Information | |||||||||
| NPI: | 1386647899 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROOKS | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | |||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 219 RUE MON JARDIN | ||||||||
| Address2: | |||||||||
| City: | MADISONVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704473703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9858454878 | ||||||||
| FaxNumber: | 9858454878 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | FRANKLINTON | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704383688 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9858394431 | ||||||||
| FaxNumber: | 9858394431 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2005 | ||||||||
| LastUpdateDate: | 01/06/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | RN033495 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 1695548 | 05 | LA | MEDICAID | 1441759 | 05 | LA | MEDICAID |