| Doctor Name: | MRS. LISA MARIE LAND |
| NPI Number: | 1083078349 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP-C |
| License Number: | AP8621 |
| Business Practice Address: | 1739 E Beverly Ave Suite 203 Kingman, AZ - 864093593 |
| Business Phone Number: | 9287573133 |
| Business Fax Number: | |
| Mailing Address: | 1739 E Beverly Ave, Suite 203 KINGMAN |
| State: | AZ |
| Postal Code: | 864093593 |
| Phone Number: | 9287573133 |
| Fax Number: | |
| NPI Enumeration Date: | 04/12/2016 |
| NPI Last Update Date: | 04/12/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | AP8621 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |