=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851373070
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISE G. COTE ARNP C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2005
-----------------------------------------------------
Last Update Date | 01/17/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14520 W GRANITE VALLEY DR SUITE 210
-----------------------------------------------------
City | SUN CITY WEST
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85375-5855
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-537-5600
-----------------------------------------------------
Fax | 866-939-2673
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18444 N 25TH AVE SUITE 310
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85023-1261
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-537-5600
-----------------------------------------------------
Fax | 866-939-2673
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | AP3479
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------