Provider Demographics
NPI:1467635292
Name:SIM, LISA MARIE REFUERZO (RN, MSN, CNS)
Entity Type:Individual
Prefix:
First Name:LISA MARIE
Middle Name:REFUERZO
Last Name:SIM
Suffix:
Gender:F
Credentials:RN, MSN, CNS
Other - Prefix:
Other - First Name:LISA MARIE
Other - Middle Name:BALDERAS
Other - Last Name:REFUERZO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6739 W CACTUS RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-5311
Mailing Address - Country:US
Mailing Address - Phone:833-242-0100
Mailing Address - Fax:623-889-0814
Practice Address - Street 1:6739 W CACTUS RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-5311
Practice Address - Country:US
Practice Address - Phone:833-242-0100
Practice Address - Fax:623-889-0814
Is Sole Proprietor?:No
Enumeration Date:2007-12-15
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ272589364SA2200X
TX721135364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health