Provider Demographics
NPI:1811147861
Name:LABARRE, LISE ANITA (MD)
Entity type:Individual
Prefix:
First Name:LISE
Middle Name:ANITA
Last Name:LABARRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LISE
Other - Middle Name:ANITA
Other - Last Name:LABARRE HOLMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7102 N. 35TH AVE
Mailing Address - Street 2:SUITE #3
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-8390
Mailing Address - Country:US
Mailing Address - Phone:602-246-3065
Mailing Address - Fax:602-246-9592
Practice Address - Street 1:7102 N 35TH AVE
Practice Address - Street 2:SUITE #3
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-8390
Practice Address - Country:US
Practice Address - Phone:602-246-3065
Practice Address - Fax:602-246-9592
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ#111522084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology