Provider Demographics
NPI:1760156194
Name:SANTANA, LISA
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:SANTANA
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 1:10490 ARBOR WAY
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-4134
Mailing Address - Country:US
Mailing Address - Phone:775-303-2236
Mailing Address - Fax:
Practice Address - Street 1:3101 PLUMAS ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-4515
Practice Address - Country:US
Practice Address - Phone:877-279-5960
Practice Address - Fax:877-384-3106
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV843518363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care