Provider Demographics
NPI:1336158666
Name:KONGABLE, LISA R (ARNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:R
Last Name:KONGABLE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:R
Other - Last Name:GARLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-353-6963
Mailing Address - Fax:319-356-2587
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-353-6963
Practice Address - Fax:319-356-2587
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAT-076356363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA500029110OtherRAILROAD MEDICARE
IA24739OtherMIDLANDS
IA463848OtherVALUE OPTIONS RAILROAD
IA0438127Medicaid
IA59200OtherWELLMARK
IAI6437Medicare ID - Type UnspecifiedMEDICARE