Lisette Pena, LM, CPM

Primary specialty

MidwifeTaxonomy code 176B00000X

License

LM250 Issued in AZ

Practice address

4121 E Pueblo Ave
Mesa, AZ 85206-5124

Phone

(602) 705-2307

NPI assigned

Nov 25, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1637798400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637798400000",
    "number": "1023775988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2113 S NIELSON ST",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852955428",
            "telephone_number": "602-705-2307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4121 E PUEBLO AVE",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852065124",
            "telephone_number": "602-705-2307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENA",
        "first_name": "LISETTE",
        "credential": "LM, CPM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-11-25",
        "last_updated": "2021-11-25",
        "certification_date": "2021-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "176B00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Midwife",
            "state": "AZ",
            "license": "LM250",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jesus Pena Nunez, STUDENT
• Crystal Pena, CPM, LM
• Izabel Anamaria Pena, M.S., CCC-SLP
• Jennifer K. Pena
• Liceett Pena, FNP-C
• Merenthia Pena, RBT
• Noelia Pena, PA
• Rogelio Pena, RD
• Amanda Phuong Thao Pendelton
• Allison Michelle Pendgraft, SLPA

• Midwife in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Midwife in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.