Provider Demographics
NPI:1700012788
Name:PEAY, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:PEAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 E 680 S
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-3593
Mailing Address - Country:US
Mailing Address - Phone:435-867-7653
Mailing Address - Fax:435-867-7699
Practice Address - Street 1:245 E 680 S
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-3593
Practice Address - Country:US
Practice Address - Phone:435-867-7653
Practice Address - Fax:435-867-7653
Is Sole Proprietor?:No
Enumeration Date:2009-06-04
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other