Healthcare Provider Details

I. General information

NPI: 1295405470
Provider Name (Legal Business Name): LISA LECOMTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2021
Last Update Date: 09/17/2021
Certification Date: 08/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E MESQUITE ST
GILBERT AZ
85296-1814
US

IV. Provider business mailing address

1000 E MESQUITE ST
GILBERT AZ
85296-1814
US

V. Phone/Fax

Practice location:
  • Phone: 480-813-1240
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN097891
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: