Provider Demographics
NPI:1104179423
Name:PULSIPHER, LISA ANN (AUD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANN
Last Name:PULSIPHER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:PULSIPHER KAISER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AUD
Mailing Address - Street 1:5 CALIENTE RD # 5
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-9100
Mailing Address - Country:US
Mailing Address - Phone:505-466-7526
Mailing Address - Fax:505-466-7528
Practice Address - Street 1:5 CALIENTE RD # 5
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87508-9100
Practice Address - Country:US
Practice Address - Phone:505-466-7526
Practice Address - Fax:505-466-7528
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMAUD5267237600000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
1104179423OtherNPI
NM95130039Medicaid