Provider Demographics
NPI:1588957179
Name:DINENNO, LISA (CNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:DINENNO
Suffix:
Gender:
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 MAIN ST UNIT 1239
Mailing Address - Street 2:
Mailing Address - City:LA LUZ
Mailing Address - State:NM
Mailing Address - Zip Code:88337-1651
Mailing Address - Country:US
Mailing Address - Phone:575-201-9860
Mailing Address - Fax:
Practice Address - Street 1:12 MAIN ST UNIT 1239
Practice Address - Street 2:
Practice Address - City:LA LUZ
Practice Address - State:NM
Practice Address - Zip Code:88337-1651
Practice Address - Country:US
Practice Address - Phone:505-918-2501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-16
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-01747363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health