Individual ProviderLisa Jayme WhitewaterRegistered NurseNursing Service ProvidersPractice Address4212 N 16th St, Phoenix, AZ 85016-5319(602) 263-1511PECOS EnrollmentBased on the most recent information from CMS, provider Lisa Jayme Whitewater does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1457428062Provider TypeIndividualFull NameWhitewater, Lisa JaymeCredentialRNGenderFemaleSole ProprietorNoEnumeration Date11/29/2006Last Updated7/8/2007Contact InformationPractice LocationPractice Address4212 N 16th St, Phoenix, AZ 85016-5319Phone(602) 263-1511Fax(602) 263-1619Mailing LocationMailing AddressPO Box 31001-0698, Pasadena, CA 91110-0698Phone(602) 263-1511Fax(602) 263-1619Provider TaxonomiesCodeDescriptionLicenseCode163W00000XPrimaryDescriptionRegistered NurseNursing Service ProvidersLicenseRN115570Arizona