Provider Demographics
NPI:1912439381
Name:HAIRSTON, LISA MARIE (APRN, CRNP, FNP-BC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:HAIRSTON
Suffix:
Gender:F
Credentials:APRN, CRNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18444 N 25TH AVE # 18
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-1261
Mailing Address - Country:US
Mailing Address - Phone:412-901-5758
Mailing Address - Fax:
Practice Address - Street 1:18444 N 25TH AVE # 18
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85023-1261
Practice Address - Country:US
Practice Address - Phone:562-684-7575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-03
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP017383363LF0000X
AZF1216319363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily