# MRS. LISA LINN MOENNING

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

## Provider details

- **NPI number:** 1972586121
- **Gender:** F
- **Credential:** PA-C PA-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | 001221 | IA | Yes |
| 363A00000X | Physician Assistant | 1862 | CO | — |

## Other

- **Enumeration date:** 11/22/2005
- **Last updated:** 01/06/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 02392 | WELLMARK BCBS | IA |