Provider Demographics
NPI:1700335064
Name:LINTNER, LISA ANN (LAC, MSTOM)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:LINTNER
Suffix:
Gender:F
Credentials:LAC, MSTOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 BUTTERCUP RD
Mailing Address - Street 2:
Mailing Address - City:HAILEY
Mailing Address - State:ID
Mailing Address - Zip Code:83333-5073
Mailing Address - Country:US
Mailing Address - Phone:208-720-6711
Mailing Address - Fax:
Practice Address - Street 1:708 BUTTERCUP RD
Practice Address - Street 2:
Practice Address - City:HAILEY
Practice Address - State:ID
Practice Address - Zip Code:83333-5073
Practice Address - Country:US
Practice Address - Phone:208-720-6711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDACU 36171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist