Provider Demographics
NPI:1760671887
Name:LISA G ABBOTT MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:LISA G ABBOTT MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:G
Authorized Official - Last Name:ABBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-786-6770
Mailing Address - Street 1:4265 ROSS DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89519-2945
Mailing Address - Country:US
Mailing Address - Phone:775-786-6770
Mailing Address - Fax:775-786-4901
Practice Address - Street 1:665 SIERRA ROSE DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2060
Practice Address - Country:US
Practice Address - Phone:775-786-6770
Practice Address - Fax:775-786-4901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6743261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVF11135Medicare UPIN
NV1609883701Medicare PIN