| Doctor Name: | MRS. LISA A WENTLING |
| NPI Number: | 1083885560 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | C0002467 |
| Business Practice Address: | 411 S. 3rd St Raton, NM - 87740 |
| Business Phone Number: | 5754453626 |
| Business Fax Number: | 5754458649 |
| Mailing Address: | 411 S 3rd St, RATON |
| State: | NM |
| Postal Code: | 87740 |
| Phone Number: | 5754453626 |
| Fax Number: | 5754458649 |
| NPI Enumeration Date: | 03/12/2008 |
| NPI Last Update Date: | 12/02/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | C0002467 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MD |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |