Provider Demographics
NPI:1053777862
Name:BROWN, LISA RENEE (FNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:RENEE
Last Name:BROWN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 W DEAN ST
Mailing Address - Street 2:
Mailing Address - City:EUNICE
Mailing Address - State:LA
Mailing Address - Zip Code:70535-2334
Mailing Address - Country:US
Mailing Address - Phone:337-580-1361
Mailing Address - Fax:
Practice Address - Street 1:1015 SANDERS STREET
Practice Address - Street 2:
Practice Address - City:PINE PRAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70576
Practice Address - Country:US
Practice Address - Phone:337-599-2850
Practice Address - Fax:337-599-2852
Is Sole Proprietor?:No
Enumeration Date:2016-01-08
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAPRN 08563363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily