Provider Demographics
NPI:1295924108
Name:MANTIA, LISA MARIE (FNP, BC)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:MANTIA
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Gender:
Credentials:FNP, BC
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Mailing Address - Street 1:PO BOX 14369
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63178-4369
Mailing Address - Country:US
Mailing Address - Phone:314-523-5300
Mailing Address - Fax:314-434-3191
Practice Address - Street 1:226 S WOODS MILL RD
Practice Address - Street 2:STE 37W
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3662
Practice Address - Country:US
Practice Address - Phone:314-523-5320
Practice Address - Fax:314-434-3191
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2003018722363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO836850716Medicare PIN