Provider Demographics
NPI:1811413958
Name:LISBOA, JAVIER (DNP)
Entity Type:Individual
Prefix:DR
First Name:JAVIER
Middle Name:
Last Name:LISBOA
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1089 JORDAN CREEK PKWY STE 116
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-5829
Mailing Address - Country:US
Mailing Address - Phone:515-327-2000
Mailing Address - Fax:515-327-2019
Practice Address - Street 1:1089 JORDAN CREEK PKWY STE 116
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-5829
Practice Address - Country:US
Practice Address - Phone:515-327-2000
Practice Address - Fax:515-327-2019
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA123014363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner