Provider Demographics
NPI:1568273191
Name:GADDINI, LISA RENATA (RN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:RENATA
Last Name:GADDINI
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 1:13207 W DESERT GLEN DR
Mailing Address - Street 2:
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-4828
Mailing Address - Country:US
Mailing Address - Phone:815-405-0010
Mailing Address - Fax:
Practice Address - Street 1:13207 W DESERT GLEN DR
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-4828
Practice Address - Country:US
Practice Address - Phone:815-405-0010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN208151207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine