Active NPI
Lisa Memmel
- Other Specialist/Technologist
- North Pole, AK
National Provider Identifier
1376239665
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Other Specialist/Technologist
- License
- 22778
- Practice address
- 1096 Copper St
North Pole, AK 99705-5775 - Phone
- (907) 460-0143
- NPI assigned
- Apr 11, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Other Specialist/Technologist | 246Z00000X | 22778 | AK | Primary |
Addresses
Primary practice location
1096 Copper St
North Pole, AK 99705-5775
Mailing address
PO Box 58659
Fairbanks, AK 99711-0659
Phone (907) 460-0143
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22778 | AK | MD | Other Specialist/Technologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1681171200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1681171200000",
"number": "1376239665",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 58659",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997110659",
"telephone_number": "907-460-0143"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1096 COPPER ST",
"city": "NORTH POLE",
"state": "AK",
"postal_code": "997055775",
"telephone_number": "907-460-0143"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEMMEL",
"first_name": "LISA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-04-11",
"last_updated": "2023-04-11",
"certification_date": "2023-04-11",
"status": "A"
},
"taxonomies": [
{
"code": "246Z00000X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other",
"state": "AK",
"license": "22778",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Pole, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.