Healthcare Provider Details

I. General information

NPI: 1861801508
Provider Name (Legal Business Name): LISA D'AUMERIES AG-ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2014
Last Update Date: 08/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6040 S FORT APACHE RD SUITE 100
LAS VEGAS NV
89148-5655
US

IV. Provider business mailing address

400 PARNASSUS AVE
SAN FRANCISCO CA
94143-2202
US

V. Phone/Fax

Practice location:
  • Phone: 702-476-4900
  • Fax:
Mailing address:
  • Phone: 702-476-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95004821
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN001786
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: