Individual
MRS. LISA INGRID NELSON-NGUYEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
3415 53RD AVE, BETTENDORF, IA 52722-6976
(563) 742-4370
(309) 558-7026
Mailing address
3415 53RD AVE, BETTENDORF, IA 52722-6976
(563) 742-4370
(309) 558-7026
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
363AM0700X
Medical Physician Assistant
001283
IA
363AM0700X
Medical Physician Assistant
01283
IA
363AM0700X
Medical Physician Assistant
085001602
IL
Other
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
—
Enumeration date
09/29/2005
Last updated
02/22/2024
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