Provider Demographics
NPI:1962692756
Name:WILLHITE, LISA CHARLINA (LPN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:CHARLINA
Last Name:WILLHITE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16750 W GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-6287
Mailing Address - Country:US
Mailing Address - Phone:623-772-4710
Mailing Address - Fax:623-772-4720
Practice Address - Street 1:16750 W GARFIELD ST
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-6287
Practice Address - Country:US
Practice Address - Phone:623-772-4710
Practice Address - Fax:623-772-4720
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP028098164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse