Provider Demographics
NPI:1871558379
Name:DAVIS, LISA A (CRNA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 SW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-1674
Mailing Address - Country:US
Mailing Address - Phone:785-295-8000
Mailing Address - Fax:785-295-5491
Practice Address - Street 1:1700 SW 7TH ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1674
Practice Address - Country:US
Practice Address - Phone:785-295-8000
Practice Address - Fax:785-295-5491
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS54265367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS144841Medicare ID - Type Unspecified