Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | AP4605 | AZ |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AP11187 | AZ |
N | 363LP2300X | Nurse Practitioner - Primary Care | AP4605 | AZ |
NPI | 1053670968 |
---|---|
Provider Name | Lisa Breiterman |
First Address | Phoenix, AZ 85012-2716 |
Second Address | Phoenix, AZ 85013 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2012 |
Last Update Date | 08/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
733126 | (05) | AZ |