Provider Demographics
NPI:1144525957
Name:ISENBERG, LISA (MSN PNP)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:ISENBERG
Suffix:
Gender:F
Credentials:MSN PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MERCADO ST
Mailing Address - Street 2:SUITE 160
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-7306
Mailing Address - Country:US
Mailing Address - Phone:970-385-9850
Mailing Address - Fax:970-385-9854
Practice Address - Street 1:1 MERCADO ST
Practice Address - Street 2:SUITE 160
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7306
Practice Address - Country:US
Practice Address - Phone:970-385-9850
Practice Address - Fax:970-385-9854
Is Sole Proprietor?:No
Enumeration Date:2011-01-26
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010041911363LP0200X, 363L00000X
COAPN.0991704-NP363LP0200X
COC-APN.0000024-C-NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner