Provider Demographics
NPI:1447402052
Name:SMITH, LISA A (FNP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:A
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:112 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW SHARON
Mailing Address - State:IA
Mailing Address - Zip Code:50207-9225
Mailing Address - Country:US
Mailing Address - Phone:641-637-2651
Mailing Address - Fax:641-637-2702
Practice Address - Street 1:112 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW SHARON
Practice Address - State:IA
Practice Address - Zip Code:50207-9225
Practice Address - Country:US
Practice Address - Phone:641-637-2651
Practice Address - Fax:641-637-2702
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA080726363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily