| Doctor Name: | LISA SHEA ROBERTS |
| NPI Number: | 1043652803 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | F.N.P. |
| License Number: | 8689112-4405 |
| Business Practice Address: | 55 E 100 N Suite 303 Logan, UT - 843214661 |
| Business Phone Number: | 4357607078 |
| Business Fax Number: | |
| Mailing Address: | 55 E 100 N, Suite 303 LOGAN |
| State: | UT |
| Postal Code: | 843214661 |
| Phone Number: | 4357607078 |
| Fax Number: | |
| NPI Enumeration Date: | 07/22/2013 |
| NPI Last Update Date: | 05/27/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 8689112-4405 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | UT |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |