| Doctor Name: | MRS. LISA MARIE ROSE-CANTRELL |
| NPI Number: | 1114053345 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | RN190406NP |
| Business Practice Address: | 5440 Hillandale Drive Kaiser Permanente Panola Medical Center Lithonia, GA - 30058 |
| Business Phone Number: | 7703223216 |
| Business Fax Number: | 7709381759 |
| Mailing Address: | 3495 Piedmont Road, Ne, Nine Piedmont Center ATLANTA |
| State: | GA |
| Postal Code: | 30305 |
| Phone Number: | 4043647070 |
| Fax Number: | 7709381759 |
| NPI Enumeration Date: | 02/23/2007 |
| NPI Last Update Date: | 10/04/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | RN190406NP |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |