MEDICARE: NATOSHA CARLING LISONBEE FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	241776	AZ

General Provider Information

NPI Number	:	1194688150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATOSHA CARLING LISONBEE FNP-C

Provider Business Mailing Address
First Line	:	5347 LAKE DR
Second Line	:
City	:	LAKESIDE
State	:	AZ
Zip	:	85929-5101
Country	:	US
Telephone Number	:	480-737-0794
Fax Number	:

Provider Business Practice Location Address
First Line	:	5347 LAKE DR
Second Line	:
City	:	LAKESIDE
State	:	AZ
Zip	:	85929-5101
Country	:	US
Telephone Number	:	480-737-0794
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2025
Last Update Date	:	12/06/2025

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