Provider Demographics
NPI:1750577581
Name:TOTH, LISA ANNE (APN)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANNE
Last Name:TOTH
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:RATCLIFF
Mailing Address - State:AR
Mailing Address - Zip Code:72951-0130
Mailing Address - Country:US
Mailing Address - Phone:479-635-0091
Mailing Address - Fax:479-635-2010
Practice Address - Street 1:#4 HIGHWAY 71 NORTHEAST
Practice Address - Street 2:
Practice Address - City:MOUNTAINBURG
Practice Address - State:AR
Practice Address - Zip Code:72946
Practice Address - Country:US
Practice Address - Phone:479-369-2091
Practice Address - Fax:479-369-4119
Is Sole Proprietor?:No
Enumeration Date:2007-09-14
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01247363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR160103758Medicaid
AR5U732Medicare PIN