Provider Demographics
NPI:1568433217
Name:LEDL, LISA A (APN)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:A
Last Name:LEDL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:A
Other - Last Name:LEDL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:1257 PAIUTE CIR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-3202
Mailing Address - Country:US
Mailing Address - Phone:702-382-0784
Mailing Address - Fax:702-384-5272
Practice Address - Street 1:1257 PAIUTE CIR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-3202
Practice Address - Country:US
Practice Address - Phone:702-382-0784
Practice Address - Fax:702-384-5272
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN00298363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2402305Medicaid
NV3102305Medicaid
S62980Medicare UPIN
NV3102305Medicaid