# MRS. LISA INGRID NELSON-NGUYEN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1619964210
- **Gender:** F
- **Credential:** PAC

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | — | — | Yes |
| 363AM0700X | Medical Physician Assistant | 001283 | IA | — |
| 363AM0700X | Medical Physician Assistant | 01283 | IA | — |
| 363AM0700X | Medical Physician Assistant | 085001602 | IL | — |

## Other

- **Enumeration date:** 09/29/2005
- **Last updated:** 02/22/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0080200 | — | IA |
| 01 | — | 079425 | HEALTH ALLIANCE | — |
| 05 | — | 1619964210 | — | IA |
| 01 | — | 421060724 | BILLING TAX ID\# FOR CHC | IA |
| 01 | — | 42106072484 | JOHN DEERE HEALTH | IA |
| 01 | — | 5100541 | CONTROLLED SUBSTANCE \# | IA |
| 01 | — | IA0184 | JOHN DEERE EDI\# | IA |
| 01 | — | P06822 | UPIN | — |