Provider Demographics
NPI:1548678493
Name:EDINBOROUGH, LISA
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:EDINBOROUGH
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 1:206 MARTIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-4591
Mailing Address - Country:US
Mailing Address - Phone:208-733-2022
Mailing Address - Fax:
Practice Address - Street 1:206 MARTIN ST STE B
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4591
Practice Address - Country:US
Practice Address - Phone:208-733-2022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy