Basic Information
| Provider Information | |||||||||
| NPI: | 1851373070 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COTE | ||||||||
| FirstName: | LISE | ||||||||
| MiddleName: | G. | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | ARNP C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GOURDEAU | ||||||||
| OtherFirstName: | LISE | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 18444 N 25TH AVE | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850231261 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235375600 | ||||||||
| FaxNumber: | 8669392673 | ||||||||
| Practice Location | |||||||||
| Address1: | 14520 W GRANITE VALLEY DR | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | SUN CITY WEST | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853755855 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235375600 | ||||||||
| FaxNumber: | 8669392673 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2005 | ||||||||
| LastUpdateDate: | 01/17/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP3479 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 061379 | 01 | ANTHEM | OTHER | 5550830007 | 01 | AZ | MEDICARE NSC DV | OTHER | 5550830006 | 01 | AZ | MEDICARE NSC ANTHEM | OTHER | 5550830010 | 01 | AZ | MEDICARE NSC GILBERT | OTHER | 5550830001 | 01 | AZ | MEDICARE NSC SCW | OTHER | 5550830008 | 01 | AZ | MEDICARE NSC SWV | OTHER | 5550830003 | 01 | AZ | MEDICARE NSC PEORIA | OTHER | 5550830009 | 01 | AZ | MEDICARE NSC AZ NORTH | OTHER | 5550830004 | 01 | AZ | MEDICARE NSC PV | OTHER |