Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 11329 | CA |
NPI | 1003851593 |
---|---|
Provider Name | Mrs. Lisa C Anderson |
First Address | Redlands, CA 92373-0722 |
Second Address | Redlands, CA 92373-5916 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2006 |
Last Update Date | 21/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P27416 | (02) | CA |
ZZZ20475Z | (05) | CA |