Provider Demographics
NPI:1114742442
Name:LIZARRAGA, BRENDA BERENICE (RN)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:BERENICE
Last Name:LIZARRAGA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 W PLUM ST
Mailing Address - Street 2:
Mailing Address - City:NOGALES
Mailing Address - State:AZ
Mailing Address - Zip Code:85621-2613
Mailing Address - Country:US
Mailing Address - Phone:520-987-0800
Mailing Address - Fax:
Practice Address - Street 1:901 E CALLE MAYER
Practice Address - Street 2:
Practice Address - City:NOGALES
Practice Address - State:AZ
Practice Address - Zip Code:85621-3410
Practice Address - Country:US
Practice Address - Phone:520-377-0544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ278855163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool