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General NPI Number Information
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NPI Number | 1962086041
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Entity Type | Individual
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Provider Name | LISA MARIE MCKINNEY APRN
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Gender | Female
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Dates
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Enumeration Date | 05/05/2021
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Last Update Date | 05/05/2021
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Provider Practice Location Address
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Address Line | 1107 US HIGHWAY 395 N
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City | GARDNERVILLE
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State | NV
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Zip | 89410-5304
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Country | US
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Telephone | 775-782-1500
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Fax |
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Provider Business Mailing Address
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Address Line | 1722 AZALEA CT
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City | MINDEN
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State | NV
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Zip | 89423-5113
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Country | US
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Telephone | 775-450-9501
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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 | 838549
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License Number State | NV
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