Healthcare Provider Details

I. General information

NPI: 1053670968
Provider Name (Legal Business Name): LISA MARIE BREITERMAN PMHNP-BC, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2012
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9929 N 95TH ST STE 101
SCOTTSDALE AZ
85258-4592
US

IV. Provider business mailing address

9929 N 95TH ST STE 101
SCOTTSDALE AZ
85258-4592
US

V. Phone/Fax

Practice location:
  • Phone: 928-375-0928
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP4605
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP11187
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP4605
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCP003354
License Number StateSD
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number094553
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: