Provider Demographics
NPI:1003054305
Name:MAHER, LISA LYNN (ARNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:LYNN
Last Name:MAHER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:LYNN
Other - Last Name:MOELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 2758
Mailing Address - Street 2:4150 KIMBALL AVE
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50704-2758
Mailing Address - Country:US
Mailing Address - Phone:319-235-5390
Mailing Address - Fax:319-235-5607
Practice Address - Street 1:419 EAST DONALD STREET
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50703-1223
Practice Address - Country:US
Practice Address - Phone:319-236-1911
Practice Address - Fax:319-287-5832
Is Sole Proprietor?:No
Enumeration Date:2009-01-26
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA114046363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1003054305Medicaid
IA1003054305OtherWELLMARK BCBS
IAP00704358 (PTAN)OtherRR MEDICARE
IA421417307-UZOtherUHC/RIVER VALLEY/JD
IA1003054305OtherWELLMARK BCBS