Healthcare Provider Details

I. General information

NPI: 1801445853
Provider Name (Legal Business Name): LISA NOBLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2019
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2711 E SCHILIRO CIR
PHOENIX AZ
85032-2453
US

IV. Provider business mailing address

PO BOX 71861
PHOENIX AZ
85050-1015
US

V. Phone/Fax

Practice location:
  • Phone: 602-769-4742
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: