MEDICARE: LISA JANDA

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	163W00000X	Registered Nurse	200075	AZ

General Provider Information

NPI Number	:	1578291852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA JANDA

Provider Business Mailing Address
First Line	:	1630 E SOUTHERN AVE
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85204-5220
Country	:	US
Telephone Number	:	480-472-5917
Fax Number	:	480-472-5992

Provider Business Practice Location Address
First Line	:	1630 E SOUTHERN AVE
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85204-5220
Country	:	US
Telephone Number	:	480-472-5917
Fax Number	:	480-472-5992

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

Provider Enumeration Date	:	08/12/2022
Last Update Date	:	08/12/2022

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Directions to “ LISA JANDA ” Practice Location

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