=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275525529
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA DRUMMOND NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2005
-----------------------------------------------------
Last Update Date | 03/21/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15650 N BLACK CANYON HWY SUITE 100
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85053-4064
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-866-0550
-----------------------------------------------------
Fax | 602-993-5788
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15650 N BLACK CANYON HWY SUITE 100
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85053-4064
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-866-0550
-----------------------------------------------------
Fax | 602-993-5788
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 208
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------