Provider Demographics
NPI:1003382524
Name:KRIEG, LISA (RN, BSN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:KRIEG
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 N LENZNER AVE
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-0905
Mailing Address - Country:US
Mailing Address - Phone:520-515-2945
Mailing Address - Fax:520-515-2948
Practice Address - Street 1:801 N LENZNER AVE
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-0905
Practice Address - Country:US
Practice Address - Phone:520-515-2945
Practice Address - Fax:520-515-2948
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN130168163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool