Healthcare Provider Details

I. General information

NPI: 1194643395
Provider Name (Legal Business Name): LISA BELLA MCPEAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 HARMONY ST STE 302
COUNCIL BLUFFS IA
51503-3106
US

IV. Provider business mailing address

303 HENSON ST
SAN DIEGO CA
92114-5611
US

V. Phone/Fax

Practice location:
  • Phone: 712-308-2609
  • Fax:
Mailing address:
  • Phone: 858-294-7513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95331482
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: