Provider Demographics
NPI:1467602896
Name:PAVLICEK, LISA COMEY (RN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:COMEY
Last Name:PAVLICEK
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 1:10841 E MIRASOL CIR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-9061
Mailing Address - Country:US
Mailing Address - Phone:480-419-6744
Mailing Address - Fax:480-419-6771
Practice Address - Street 1:10841 E MIRASOL CIR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-9061
Practice Address - Country:US
Practice Address - Phone:480-419-6744
Practice Address - Fax:480-419-6771
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-22
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN083280163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse