Pauline Lerma Neiswonger, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

234646 Issued in AZ

Practice address

2842 E Inca LN
San Tan Valley, AZ 85140-1324

Phone

(480) 323-3000

NPI assigned

Dec 5, 2019

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

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The Arizona Partnership for Immunization

  • Public Health or Welfare Agency
  • Phoenix, AZ
  • NPI 1942532189

  Single Specialty

  Medicare reassignment NPD

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

{
    "created_epoch": "1575504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621555200000",
    "number": "1922645191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2842 E INCA LN",
            "city": "SAN TAN VALLEY",
            "state": "AZ",
            "postal_code": "851401324",
            "telephone_number": "480-323-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2842 E INCA LN",
            "city": "SAN TAN VALLEY",
            "state": "AZ",
            "postal_code": "851401324",
            "telephone_number": "480-323-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEISWONGER",
        "first_name": "PAULINE",
        "middle_name": "LERMA",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-12-05",
        "last_updated": "2021-05-21",
        "certification_date": "2021-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "234646",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gabrielle Christine Nance, MS CCC-SLP
• Krishna Satya Narla, RPH
• National Vision Inc
• National Vision, Inc
• Nationwide Optometry P.C.
• Kari Lynn Neubauer Potthoff, PHD, LMFT
• Megan Nevitt
• New Destiny Healing LLC
• New Destiny Healing LLC
• New Heights Amethyst LLC

• Family Nurse Practitioner in San Tan Valley, AZ
• Providers in San Tan Valley, AZ by specialty
• Family Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.