Provider Demographics
NPI:1851781538
Name:WIEBE, LISA M (APRN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:WIEBE
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 N MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:MCPHERSON
Mailing Address - State:KS
Mailing Address - Zip Code:67460-2839
Mailing Address - Country:US
Mailing Address - Phone:620-220-1225
Mailing Address - Fax:620-299-0131
Practice Address - Street 1:823 N MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:MCPHERSON
Practice Address - State:KS
Practice Address - Zip Code:67460-2839
Practice Address - Country:US
Practice Address - Phone:620-220-1225
Practice Address - Fax:620-299-0131
Is Sole Proprietor?:No
Enumeration Date:2015-02-02
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-76408-112363LF0000X
KS53-76408363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily