Provider Demographics
NPI:1346503117
Name:REINERTSON, LISA NICOLE (PA-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:NICOLE
Last Name:REINERTSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1639 W WELDON AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-5524
Mailing Address - Country:US
Mailing Address - Phone:602-521-3250
Mailing Address - Fax:602-521-3251
Practice Address - Street 1:755 E MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2506
Practice Address - Country:US
Practice Address - Phone:602-521-3250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2022-04-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ5145363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical