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General NPI Number Information
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NPI Number | 1578628384
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Entity Type | Individual
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Provider Name | DONNA LISANSKY APRN,BC
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Gender | Female
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 06/24/2009
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Provider Practice Location Address
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Address Line | 1501 SAN PEDRO DR SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87108-5153
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Country | US
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Telephone | 505-332-2737
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Fax |
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Provider Business Mailing Address
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Address Line | 11411 PENFIELD LN NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-6524
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number | R23073
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License Number State | NM
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