Provider Demographics
NPI:1922408327
Name:CHICA, LISA NICOLE (RN, CNP, PMHNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:NICOLE
Last Name:CHICA
Suffix:
Gender:F
Credentials:RN, CNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1642 S PRIEST DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-6204
Mailing Address - Country:US
Mailing Address - Phone:631-428-4999
Mailing Address - Fax:
Practice Address - Street 1:1642 S PRIEST DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-6204
Practice Address - Country:US
Practice Address - Phone:631-428-4999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-04
Last Update Date:2020-08-26
Deactivation Date:2020-08-19
Deactivation Code:
Reactivation Date:2020-08-26
Provider Licenses
StateLicense IDTaxonomies
NY689339163W00000X
AZ230421363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse