Provider Demographics
NPI:1902933922
Name:NESTINGEN, LISA M
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:NESTINGEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7652 S BALSAM CT
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80128-8273
Mailing Address - Country:US
Mailing Address - Phone:720-981-5084
Mailing Address - Fax:
Practice Address - Street 1:5257 S WADSWORTH BLVD
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-2228
Practice Address - Country:US
Practice Address - Phone:303-972-5039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO118339163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
014723OtherKAISER-COMMERCIAL NUMBER