Provider Demographics
NPI:1588729446
Name:LECORGNE, LISETTE MARY (NP)
Entity type:Individual
Prefix:MS
First Name:LISETTE
Middle Name:MARY
Last Name:LECORGNE
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:5133 E ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-4105
Mailing Address - Country:US
Mailing Address - Phone:520-621-8315
Mailing Address - Fax:520-626-2760
Practice Address - Street 1:1224 E LOWELL ST
Practice Address - Street 2:BLDG. 95 CAMPUS HEALTH
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85721-0095
Practice Address - Country:US
Practice Address - Phone:520-621-8315
Practice Address - Fax:520-626-2760
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZRN038858363LS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LS0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerSchool