Provider Demographics
NPI:1942594080
Name:NASH, LISA JEANNINE (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:JEANNINE
Last Name:NASH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:JEANNINE
Other - Last Name:HOLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:920 STANTON L YOUNG BLVD
Mailing Address - Street 2:WP-1380
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-5036
Mailing Address - Country:US
Mailing Address - Phone:405-271-5964
Mailing Address - Fax:405-271-4719
Practice Address - Street 1:5890 W 13TH ST STE 101
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-4821
Practice Address - Country:US
Practice Address - Phone:970-810-0020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK28523207X00000X
CODR.0059043207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery