Provider Demographics
NPI:1790967081
Name:GLANTZ, LISA M (RNC-NIC, ARNP, DNP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:M
Last Name:GLANTZ
Suffix:
Gender:F
Credentials:RNC-NIC, ARNP, DNP
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:GLANTZ-WILLIAMSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NNP
Mailing Address - Street 1:1200 PLEASANT ST
Mailing Address - Street 2:BLANK CHILDRENS HOSPITAL NICU
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1406
Mailing Address - Country:US
Mailing Address - Phone:515-241-5926
Mailing Address - Fax:515-241-5127
Practice Address - Street 1:1200 PLEASANT ST
Practice Address - Street 2:BLANK CHILDRENS HOSPITAL NICU
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1406
Practice Address - Country:US
Practice Address - Phone:515-241-5926
Practice Address - Fax:515-241-5127
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAK105229363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1790967081Medicaid
NE100264995-00Medicaid
IA175150044Medicare PIN