Provider Demographics
NPI:1043674666
Name:ARNOLD, LISA M (DO)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:MIDBOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5171 S. COTTONWOOD ST.
Mailing Address - Street 2:BLDG 1, STE 610
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107
Mailing Address - Country:US
Mailing Address - Phone:801-507-3630
Mailing Address - Fax:
Practice Address - Street 1:5171 S. COTTONWOOD ST.
Practice Address - Street 2:BUILDING 1; STE. 610
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107
Practice Address - Country:US
Practice Address - Phone:801-507-3630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-09
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT031.01291662084N0400X
UT12233984-12042084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology