Active NPI
Lisa L Cervantes, PAC
- Physician Assistant
- Madison, WI
National Provider Identifier
1609843192
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 990
- Practice address
- 1004 Garfield St
Madison, WI 53711-2156 - Phone
- (000) 000-0000
- NPI assigned
- Mar 2, 2006
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 990 | WI | Primary |
Addresses
Primary practice location
1004 Garfield St
Madison, WI 53711-2156
Mailing address
1004 Garfield St
Madison, WI 53711-2156
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 990 | WI | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141257600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1696204800000",
"number": "1609843192",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1004 GARFIELD ST",
"city": "MADISON",
"state": "WI",
"postal_code": "537112156"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1004 GARFIELD ST",
"city": "MADISON",
"state": "WI",
"postal_code": "537112156",
"telephone_number": "000-000-0000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CERVANTES",
"first_name": "LISA",
"middle_name": "L",
"credential": "PAC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-02",
"last_updated": "2023-10-02",
"certification_date": "2023-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WI",
"license": "990",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Madison, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 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.