Provider Demographics
NPI:1003213422
Name:STANLEY, LISA A (APN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:STANLEY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3641 HIGHWAY 95
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-8151
Mailing Address - Country:US
Mailing Address - Phone:928-758-2373
Mailing Address - Fax:928-758-2166
Practice Address - Street 1:3641 HIGHWAY 95
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-8151
Practice Address - Country:US
Practice Address - Phone:928-758-2373
Practice Address - Fax:928-758-2166
Is Sole Proprietor?:No
Enumeration Date:2014-12-01
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP7449363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ8921242OtherCIGNA
AZ004593Medicaid
AZP02470069OtherRR MEDICARE