Provider Demographics
NPI:1003349556
Name:KAHANA-NAIPO, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:KAHANA-NAIPO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 GLENWOOD DR STE E786
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-1192
Mailing Address - Country:US
Mailing Address - Phone:423-682-8150
Mailing Address - Fax:423-682-8151
Practice Address - Street 1:725 GLENWOOD DR STE E786
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1192
Practice Address - Country:US
Practice Address - Phone:423-682-8150
Practice Address - Fax:423-682-8151
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-11
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22512363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily