Provider Demographics
NPI:1801299078
Name:LING, LISA (NP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:LING
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:LISA TSEH
Other - Middle Name:
Other - Last Name:LING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 25880
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85367-1340
Mailing Address - Country:US
Mailing Address - Phone:928-257-0993
Mailing Address - Fax:
Practice Address - Street 1:1233 N MAIN ST STE 10
Practice Address - Street 2:
Practice Address - City:SAN LUIS
Practice Address - State:AZ
Practice Address - Zip Code:85336-0663
Practice Address - Country:US
Practice Address - Phone:928-257-0993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5639363LF0000X, 363LP0808X
NM73401363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ133227Medicare UPIN