Basic Information
| Provider Information | |||||||||
| NPI: | 1942594080 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NASH | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | JEANNINE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HOLEMAN | ||||||||
| OtherFirstName: | LISA | ||||||||
| OtherMiddleName: | JEANNINE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 920 STANTON L YOUNG BLVD | ||||||||
| Address2: | WP-1380 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731045036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052715964 | ||||||||
| FaxNumber: | 4052714719 | ||||||||
| Practice Location | |||||||||
| Address1: | 5890 W 13TH ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | GREELEY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 806344821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9708100020 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2011 | ||||||||
| LastUpdateDate: | 07/02/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 28523 | OK | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | DR.0059043 | CO | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XS0106X | DR.0059043 | CO | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery |
No ID Information.