Provider Demographics
NPI:1538544903
Name:GEIS, ELIZABETH I (LPN)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:
Last Name:GEIS
Suffix:I
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3415 N 59TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85033-4623
Mailing Address - Country:US
Mailing Address - Phone:602-764-2000
Mailing Address - Fax:602-764-2095
Practice Address - Street 1:3415 N 59TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85033-4623
Practice Address - Country:US
Practice Address - Phone:602-764-2000
Practice Address - Fax:602-764-2095
Is Sole Proprietor?:No
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP000032852164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse