Provider Demographics
NPI:1023207784
Name:LANNING, LISA CHRISTINA (DO)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:CHRISTINA
Last Name:LANNING
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:CHRISTINA
Other - Last Name:LANNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO, PA
Mailing Address - Street 1:PO BOX 190930
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83719-0930
Mailing Address - Country:US
Mailing Address - Phone:208-367-5170
Mailing Address - Fax:208-367-5180
Practice Address - Street 1:3325 POCAHONTAS RD
Practice Address - Street 2:
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814-1464
Practice Address - Country:US
Practice Address - Phone:541-524-8000
Practice Address - Fax:541-524-7955
Is Sole Proprietor?:No
Enumeration Date:2007-10-18
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDO36693207Q00000X
SCPA 1131363AM0700X
ORPA 00746363AM0700X
SCLL36693207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP79454Medicare UPIN
SCAA25239326Medicare PIN