Individual
MS. LISA MARIE LUICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
3555 E FRY BLVD, SIERRA VISTA, AZ 85635-2972
(520) 515-2872
Mailing address
6070 S CALLE DE LA MENTA, HEREFORD, AZ 85615-9512
(520) 803-0590
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
RN136448
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
579633
—
AZ
Enumeration date
05/27/2011
Last updated
05/27/2011
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