Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | RN105827 | AZ |
NPI | 1013158195 |
---|---|
Provider Name | Miss Lisa M Dimenna |
First Address | Tucson, AZ 85724-5073 |
Second Address | Tucson, AZ 85724-5073 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2009 |
Last Update Date | 27/07/2010 |