Healthcare Provider Details

I. General information

NPI: 1407981368
Provider Name (Legal Business Name): LISA ANN BILEK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 05/25/2022
Certification Date: 05/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10524 E HIGHWAY 92
HEREFORD AZ
85615-8371
US

IV. Provider business mailing address

4655 N COMMERCE DR
SIERRA VISTA AZ
85635-2497
US

V. Phone/Fax

Practice location:
  • Phone: 520-366-0300
  • Fax: 520-366-0440
Mailing address:
  • Phone: 520-459-3012
  • Fax: 520-459-3207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN049062/AP3347
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: