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General NPI Number Information
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NPI Number | 1043652803
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Entity Type | Individual
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Provider Name | LISA SHEA ROBERTS F.N.P.
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Gender | Female
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Dates
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Enumeration Date | 07/22/2013
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Last Update Date | 06/24/2019
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Provider Practice Location Address
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Address Line | 55 E 100 N SUITE 303
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City | LOGAN
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State | UT
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Zip | 84321-4661
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Country | US
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Telephone | 435-760-7078
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Fax |
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Provider Business Mailing Address
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Address Line | 12965 W 61ST CIR
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City | ARVADA
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State | CO
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Zip | 80004-3981
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Country | US
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Telephone | 435-760-7078
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 8689112-4405
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 8689112-4405
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License Number State | UT
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