1033434832 NPI number — MS. SHERRI ANN JOE LISAC

Table of content: MS. SHERRI ANN JOE LISAC (NPI 1033434832)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033434832 NPI number — MS. SHERRI ANN JOE LISAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOE
Provider First Name:
SHERRI
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LISAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033434832
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/16/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 777
Provider Second Line Business Mailing Address:
NAVAJO ROUTE 7 & BIA ROUTE 102.1
Provider Business Mailing Address City Name:
CHINLE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-674-2268
Provider Business Mailing Address Fax Number:
928-674-2191

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ROUTE 7
Provider Second Line Business Practice Location Address:
ROUTE 7
Provider Business Practice Location Address City Name:
CHINLE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-674-2570
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/05/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  LISAC-11492 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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