Healthcare Provider Details

I. General information

NPI: 1730251034
Provider Name (Legal Business Name): LISA D'ALESSANDRO-BETANCOURT N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 01/29/2020
Certification Date: 01/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11361 N 99TH AVE STE 200
PEORIA AZ
85345-5470
US

IV. Provider business mailing address

3450 N 3RD ST
PHOENIX AZ
85012-2331
US

V. Phone/Fax

Practice location:
  • Phone: 602-636-1212
  • Fax:
Mailing address:
  • Phone: 602-265-8338
  • Fax: 602-265-8574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP3012
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN086946
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: