Lisa Nicole Bengtson, MS, ATC, LAT

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

000787 Issued in IA

Practice address

610 W 4TH St
Storm Lake, IA 50588-1713

Phone

(712) 749-2021

Fax

(712) 749-1460

NPI assigned

Mar 31, 2014

Last updated

Mar 31, 2014By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1396224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1396224000000",
    "number": "1568880375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 SAINT ANDREWS DR",
            "city": "STORM LAKE",
            "state": "IA",
            "postal_code": "505887800",
            "telephone_number": "712-299-1134",
            "fax_number": "712-749-1460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 W 4TH ST",
            "city": "STORM LAKE",
            "state": "IA",
            "postal_code": "505881713",
            "telephone_number": "712-749-2021",
            "fax_number": "712-749-1460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENGTSON",
        "first_name": "LISA",
        "middle_name": "NICOLE",
        "name_prefix": "Ms.",
        "credential": "MS, ATC, LAT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-03-31",
        "last_updated": "2014-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IA",
            "license": "000787",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Athletic Trainer in Storm Lake, IA
• Providers in Storm Lake, IA by specialty
• Athletic Trainer in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.