Provider Demographics
NPI:1790484632
Name:YORK, LISA MARIE (PMHNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:YORK
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 29TH ST STE 305
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1309
Mailing Address - Country:US
Mailing Address - Phone:515-985-2024
Mailing Address - Fax:
Practice Address - Street 1:1441 29TH ST STE 305
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1309
Practice Address - Country:US
Practice Address - Phone:515-985-2024
Practice Address - Fax:515-985-2025
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG173104363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health