Individual
GINA LISCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
15474 W GREENWAY RD, SURPRISE, AZ 85374-4348
(623) 584-1964
(623) 544-2359
Mailing address
1 CVS DR, WOONSOCKET, RI 02895-6146
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN138704AP2390
AZ
363LF0000X
Family Nurse Practitioner
RN155396NP07758
OH
363LF0000X
Family Nurse Practitioner
RN297329NP5983
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2521462
—
OH
01
—
341458069GL
SUMMA INSURANCE
OH
Enumeration date
03/07/2006
Last updated
12/09/2021
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