Provider Demographics
NPI:1881065266
Name:BABA, LISA (FNP-C)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BABA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21300 N. JOHN WAYNE PKWY
Mailing Address - Street 2:#112
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85139
Mailing Address - Country:US
Mailing Address - Phone:520-568-9500
Mailing Address - Fax:520-568-9533
Practice Address - Street 1:21300 N. JOHN WAYNE PKWY
Practice Address - Street 2:#112
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139
Practice Address - Country:US
Practice Address - Phone:520-568-9500
Practice Address - Fax:520-568-9533
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-12
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8214363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily