Provider Demographics
NPI:1376720227
Name:RINGENBERG, LISA B (CNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:B
Last Name:RINGENBERG
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:BOURNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:900 S MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:AZTEC
Mailing Address - State:NM
Mailing Address - Zip Code:87410-2285
Mailing Address - Country:US
Mailing Address - Phone:505-333-3832
Mailing Address - Fax:505-333-3871
Practice Address - Street 1:900 S MAIN AVE
Practice Address - Street 2:
Practice Address - City:AZTEC
Practice Address - State:NM
Practice Address - Zip Code:87410-2285
Practice Address - Country:US
Practice Address - Phone:505-333-3832
Practice Address - Fax:505-333-3871
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR38231163W00000X, 363LF0000X
CO5468363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM5530770Medicaid