Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | AP7449 | AZ |
NPI | 1003213422 |
---|---|
Provider Name | Lisa A Stanley |
First Address | Bullhead City, AZ 86442-8151 |
Second Address | Bullhead City, AZ 86442-8151 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2014 |
Last Update Date | 29/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004593 | (05) | AZ |
8921242 | CIGNA (01) | AZ |
P02470069 | RR MEDICARE (01) | AZ |