Provider Demographics
NPI:1972586121
Name:MOENNING, LISA LINN (PA-C PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:LINN
Last Name:MOENNING
Suffix:
Gender:F
Credentials:PA-C PA-C
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:LINN
Other - Last Name:PARRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DRIVE
Mailing Address - Street 2:1008 RCP
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242
Mailing Address - Country:US
Mailing Address - Phone:319-353-6360
Mailing Address - Fax:319-353-7006
Practice Address - Street 1:200 HAWKINS DRIVE
Practice Address - Street 2:1008 RCP
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242
Practice Address - Country:US
Practice Address - Phone:319-353-6360
Practice Address - Fax:319-353-7006
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1862363A00000X
IA001221363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA02392OtherWELLMARK BCBS
IAI18742Medicare PIN
S85083Medicare UPIN
IA089770002Medicare PIN
IA02392OtherWELLMARK BCBS