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General NPI Number Information
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NPI Number | 1912439381
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Entity Type | Individual
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Provider Name | LISA MARIE HAIRSTON APRN, CRNP, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 04/03/2017
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 18444 N 25TH AVE # 18
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City | PHOENIX
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State | AZ
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Zip | 85023-1261
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Country | US
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Telephone | 562-684-7575
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Fax |
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Provider Business Mailing Address
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Address Line | 18444 N 25TH AVE # 18
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City | PHOENIX
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State | AZ
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Zip | 85023-1261
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Country | US
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Telephone | 412-901-5758
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SP017383
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License Number State | PA
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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 | F1216319
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License Number State | AZ
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