Healthcare Provider Details

I. General information

NPI: 1124944277
Provider Name (Legal Business Name): LISA S O'NEAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

284 MARTIN ST
TWIN FALLS ID
83301-4542
US

IV. Provider business mailing address

284 MARTIN ST
TWIN FALLS ID
83301-4542
US

V. Phone/Fax

Practice location:
  • Phone: 208-733-7186
  • Fax: 208-733-7171
Mailing address:
  • Phone: 208-733-7186
  • Fax: 208-733-7171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: