Provider Demographics
NPI:1922541515
Name:MARCONI, LISA (RN)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:MARCONI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 S BROADWAY AVE
Mailing Address - Street 2:SUITE 505
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-3600
Mailing Address - Country:US
Mailing Address - Phone:208-780-6255
Mailing Address - Fax:208-780-6291
Practice Address - Street 1:960 S BROADWAY AVE
Practice Address - Street 2:SUITE 505
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-3600
Practice Address - Country:US
Practice Address - Phone:208-780-6255
Practice Address - Fax:208-780-6291
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN-26683163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management