Provider Demographics
NPI:1851373070
Name:COTE, LISE G (ARNP C)
Entity Type:Individual
Prefix:MRS
First Name:LISE
Middle Name:G
Last Name:COTE
Suffix:
Gender:F
Credentials:ARNP C
Other - Prefix:
Other - First Name:LISE
Other - Middle Name:
Other - Last Name:GOURDEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18444 N 25TH AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-1261
Mailing Address - Country:US
Mailing Address - Phone:623-537-5600
Mailing Address - Fax:866-939-2673
Practice Address - Street 1:14520 W GRANITE VALLEY DR
Practice Address - Street 2:SUITE 210
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-5855
Practice Address - Country:US
Practice Address - Phone:623-537-5600
Practice Address - Fax:866-939-2673
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3479363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
061379OtherANTHEM
AZ5550830007OtherMEDICARE NSC DV
AZ5550830006OtherMEDICARE NSC ANTHEM
AZ5550830010OtherMEDICARE NSC GILBERT
AZ5550830001OtherMEDICARE NSC SCW
AZ5550830008OtherMEDICARE NSC SWV
AZ5550830003OtherMEDICARE NSC PEORIA
AZ5550830009OtherMEDICARE NSC AZ NORTH
AZ5550830004OtherMEDICARE NSC PV
AZ5550830007OtherMEDICARE NSC DV
AZ5550830006OtherMEDICARE NSC ANTHEM
AZ5550830009OtherMEDICARE NSC AZ NORTH
MEP33453Medicare UPIN