Provider Demographics
NPI:1912338724
Name:HORTON, LISA JO (MSN, RN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:JO
Last Name:HORTON
Suffix:
Gender:F
Credentials:MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 AVENUE F
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-2420
Mailing Address - Country:US
Mailing Address - Phone:307-272-3605
Mailing Address - Fax:
Practice Address - Street 1:556 AVENUE F
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-2420
Practice Address - Country:US
Practice Address - Phone:307-272-3605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY21305163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse