Provider Demographics
NPI:1316042625
Name:NETTEN-FOSTER, LISA ANN (PAC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:NETTEN-FOSTER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:NETTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3600 30TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310
Mailing Address - Country:US
Mailing Address - Phone:515-699-5999
Mailing Address - Fax:515-643-5150
Practice Address - Street 1:411 LAUREL ST
Practice Address - Street 2:SUITE 3262
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-3017
Practice Address - Country:US
Practice Address - Phone:515-643-5100
Practice Address - Fax:515-643-5150
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1522363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA36208OtherWELLMARK
IAI11230Medicare PIN
IA36208OtherWELLMARK