Provider Demographics
NPI:1669820114
Name:MCINERNEY, LISA ROACH
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ROACH
Last Name:MCINERNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ROACH
Other - Last Name:PIKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1432 INGRA ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-5434
Mailing Address - Country:US
Mailing Address - Phone:907-762-8687
Mailing Address - Fax:
Practice Address - Street 1:1432 INGRA ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-5434
Practice Address - Country:US
Practice Address - Phone:907-762-8687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor