Provider Demographics
NPI:1033385182
Name:ROBERTS, LISA ANNE (RN)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANNE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10654 E ANANEA AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85208-8738
Mailing Address - Country:US
Mailing Address - Phone:480-218-5797
Mailing Address - Fax:
Practice Address - Street 1:10654 E ANANEA AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85208-8738
Practice Address - Country:US
Practice Address - Phone:480-218-5797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN117825163WC1600X, 163WX0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No163WX0002XNursing Service ProvidersRegistered NurseObstetric, High-Risk