Provider Demographics
NPI:1528838471
Name:CANTRELL, LISA ANNE (RN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANNE
Last Name:CANTRELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANNE
Other - Last Name:VANDERZIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1575 DELUCCHI LN
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-6578
Mailing Address - Country:US
Mailing Address - Phone:775-842-3428
Mailing Address - Fax:
Practice Address - Street 1:1575 DELUCCHI LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-6578
Practice Address - Country:US
Practice Address - Phone:775-432-1223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN24873163WD1100X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WD1100XNursing Service ProvidersRegistered NurseDialysis, Peritoneal