Provider Demographics
NPI:1538466834
Name:LADENBURGER, LISA JEAN (LADENBURGER LISA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:JEAN
Last Name:LADENBURGER
Suffix:
Gender:F
Credentials:LADENBURGER LISA
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:JEAN
Other - Last Name:LADENBURGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BREASTHETICIAN
Mailing Address - Street 1:2908 S BELLEPINE CIR
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103-4800
Mailing Address - Country:US
Mailing Address - Phone:605-376-1615
Mailing Address - Fax:605-339-3778
Practice Address - Street 1:1700 S MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1723
Practice Address - Country:US
Practice Address - Phone:605-376-1615
Practice Address - Fax:605-339-3778
Is Sole Proprietor?:No
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1023-9814-ST246ZA2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZA2600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherArt, Medical