Provider Demographics
NPI:1912991357
Name:LEPPERT, LISA DEE (FNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:DEE
Last Name:LEPPERT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2213 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-5305
Mailing Address - Country:US
Mailing Address - Phone:515-237-3974
Mailing Address - Fax:515-883-2692
Practice Address - Street 1:1303 11TH AVE
Practice Address - Street 2:
Practice Address - City:MANSON
Practice Address - State:IA
Practice Address - Zip Code:50563-5065
Practice Address - Country:US
Practice Address - Phone:712-469-3307
Practice Address - Fax:712-469-2614
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA-053142363LF0000X
IA053142163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA7425090Medicaid
IB4749002OtherMEDICARE UPIN
00675306106OtherUNITED HEALTHCARE
303255OtherMIDLAND'S CHOICE
IAC00000015557OtherBCBS OF IOWA
IAP00258326OtherRAILROAD MEDICARE PIN
IA0689547Medicaid
IA6180702OtherAETNA
IA12137294OtherAMERIGROUP OF IOWA
IA8831785OtherCIGNA
IAPSO1OtherIOWA TOTAL CARE