Provider Demographics
NPI:1548560105
Name:ANDERSON, LISA M (L AC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3429 E MELODY DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-7263
Mailing Address - Country:US
Mailing Address - Phone:602-470-8473
Mailing Address - Fax:
Practice Address - Street 1:1801 S JENTILLY LN
Practice Address - Street 2:SUITE A-18
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-5758
Practice Address - Country:US
Practice Address - Phone:602-531-5511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-29
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0732171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist