Provider Demographics
NPI:1013158195
Name:DIMENNA, LISA M (RN, NNP-BC)
Entity Type:Individual
Prefix:MISS
First Name:LISA
Middle Name:M
Last Name:DIMENNA
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Gender:F
Credentials:RN, NNP-BC
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Mailing Address - Street 1:1501 N CAMPBELL AVE
Mailing Address - Street 2:PO BOX 245073
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85724-5073
Mailing Address - Country:US
Mailing Address - Phone:520-626-6627
Mailing Address - Fax:520-626-5009
Practice Address - Street 1:1501 N CAMPBELL AVE
Practice Address - Street 2:3341
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85724-5073
Practice Address - Country:US
Practice Address - Phone:520-626-6627
Practice Address - Fax:520-626-5009
Is Sole Proprietor?:No
Enumeration Date:2009-03-18
Last Update Date:2010-07-27
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Provider Licenses
StateLicense IDTaxonomies
AZRN105827363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care