Provider Demographics
NPI:1336164805
Name:MENZIE, LISA D (NP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:D
Last Name:MENZIE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7733 W NORTH LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-6600
Mailing Address - Country:US
Mailing Address - Phone:623-773-2323
Mailing Address - Fax:
Practice Address - Street 1:7733 W NORTH LN
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-6600
Practice Address - Country:US
Practice Address - Phone:623-773-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP1945363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZQ49640Medicare UPIN
AZZ122589Medicare PIN
Z127041Medicare PIN