Healthcare Provider Details

I. General information

NPI: 1104179423
Provider Name (Legal Business Name): LISA ANN PULSIPHER AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA ANN PULSIPHER KAISER AUD

II. Dates (important events)

Enumeration Date: 10/24/2012
Last Update Date: 02/09/2022
Certification Date: 02/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 CALIENTE RD # 5
SANTA FE NM
87508-9100
US

IV. Provider business mailing address

5 CALIENTE RD # 5
SANTA FE NM
87508-9100
US

V. Phone/Fax

Practice location:
  • Phone: 505-466-7526
  • Fax: 505-466-7528
Mailing address:
  • Phone: 505-466-7526
  • Fax: 505-466-7528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAUD5267
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: