Provider Demographics
NPI:1235289745
Name:LOTTIS, KAREN J (PHD, FNP)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:J
Last Name:LOTTIS
Suffix:
Gender:F
Credentials:PHD, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 E YAVAPAI ST
Mailing Address - Street 2:
Mailing Address - City:WICKENBURG
Mailing Address - State:AZ
Mailing Address - Zip Code:85390-2712
Mailing Address - Country:US
Mailing Address - Phone:928-684-3153
Mailing Address - Fax:928-684-3141
Practice Address - Street 1:55 E YAVAPAI ST
Practice Address - Street 2:
Practice Address - City:WICKENBURG
Practice Address - State:AZ
Practice Address - Zip Code:85390-2712
Practice Address - Country:US
Practice Address - Phone:928-684-3153
Practice Address - Fax:928-684-3141
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3541363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily