Provider Demographics
NPI:1487955357
Name:DUGAN, LISA KAY (FNP-C)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:KAY
Last Name:DUGAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4902 E SHEA BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-4184
Mailing Address - Country:US
Mailing Address - Phone:480-214-4468
Mailing Address - Fax:480-607-6883
Practice Address - Street 1:4902 E SHEA BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-4184
Practice Address - Country:US
Practice Address - Phone:480-214-4468
Practice Address - Fax:480-607-6883
Is Sole Proprietor?:No
Enumeration Date:2010-11-09
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN111149163W00000X
AZAP3859363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse