Provider Demographics
NPI:1942734116
Name:LINTZENICH, LISA ANN (CNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:LINTZENICH
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 MONTANO RD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-5743
Mailing Address - Country:US
Mailing Address - Phone:505-992-2997
Mailing Address - Fax:
Practice Address - Street 1:4201 MONTANO RD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-5743
Practice Address - Country:US
Practice Address - Phone:505-922-4997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-14
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH020604363LF0000X
NM57168363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH221122Medicaid