Basic Information
| Provider Information | |||||||||
| NPI: | 1851830418 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DARRAH | ||||||||
| FirstName: | LISA | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5653 S HIGHWAY 95 | ||||||||
| Address2: | |||||||||
| City: | FORT MOHAVE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 864266068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287682558 | ||||||||
| FaxNumber: | 9287682874 | ||||||||
| Practice Location | |||||||||
| Address1: | 56 N PECOS RD | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890747331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028775199 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2017 | ||||||||
| LastUpdateDate: | 08/31/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | AP9791 | AZ | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363L00000X | 843117 | NV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.