Provider Demographics
NPI:1114992278
Name:JAMES, LISA R (ARNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:R
Last Name:JAMES
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 4TH AVE W
Mailing Address - Street 2:
Mailing Address - City:GRINNELL
Mailing Address - State:IA
Mailing Address - Zip Code:50112-1895
Mailing Address - Country:US
Mailing Address - Phone:641-236-7524
Mailing Address - Fax:641-236-7944
Practice Address - Street 1:217 4TH AVE W
Practice Address - Street 2:
Practice Address - City:GRINNELL
Practice Address - State:IA
Practice Address - Zip Code:50112-1895
Practice Address - Country:US
Practice Address - Phone:641-236-7524
Practice Address - Fax:641-236-7944
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA097367363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA18118OtherMEDICARE GROUP NUMBER
IA18118OtherMEDICARE GROUP NUMBER