Provider Demographics
NPI:1962513432
Name:COVARRUBIAS, LISA M (RN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:COVARRUBIAS
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 1:10221 CHRIS DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46229-1875
Mailing Address - Country:US
Mailing Address - Phone:317-891-0342
Mailing Address - Fax:
Practice Address - Street 1:3838 N RURAL ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-2930
Practice Address - Country:US
Practice Address - Phone:317-221-2306
Practice Address - Fax:317-221-2336
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28098577A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse