Healthcare Provider Details

I. General information

NPI: 1003213422
Provider Name (Legal Business Name): LISA A STANLEY APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2014
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 HWAY 95 STE 105
BULLHEAD CITY AZ
86442-4334
US

IV. Provider business mailing address

3015 HWAY 95 STE 105
BULLHEAD CITY AZ
86442-4334
US

V. Phone/Fax

Practice location:
  • Phone: 928-763-2001
  • Fax: 928-763-2038
Mailing address:
  • Phone: 928-763-2001
  • Fax: 928-763-2038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP7449
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: