Provider Demographics
NPI:1174791081
Name:SCHAFER, LISA ANN (APN)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANN
Last Name:SCHAFER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 PETRO RD
Mailing Address - Street 2:STE 11
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301
Mailing Address - Country:US
Mailing Address - Phone:870-732-0332
Mailing Address - Fax:870-732-3078
Practice Address - Street 1:3900 PETRO RD
Practice Address - Street 2:STE 11
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301
Practice Address - Country:US
Practice Address - Phone:870-732-0332
Practice Address - Fax:870-732-3078
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAO1128208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y635OtherBLUE CROSS PTAN