Healthcare Provider Details

I. General information

NPI: 1609530302
Provider Name (Legal Business Name): LISA ANN COSTE RN, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2021
Last Update Date: 09/11/2025
Certification Date: 10/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 CAMPUS DR
SIERRA VISTA AZ
85635-2449
US

IV. Provider business mailing address

1423 CALLE ESPERANZA
SIERRA VISTA AZ
85635-2372
US

V. Phone/Fax

Practice location:
  • Phone: 520-458-3932
  • Fax:
Mailing address:
  • Phone: 520-249-6856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN91983
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: