MEDICARE: MS. LISA A. FREY N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	397488	CA

General Provider Information

NPI Number	:	1861486359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA A. FREY N.P.

Provider Business Mailing Address
First Line	:	305 SEQUOIA AVE
Second Line	:
City	:	REDWOOD CITY
State	:	CA
Zip	:	94061-3426
Country	:	US
Telephone Number	:	650-365-3464
Fax Number	:	650-365-3464

Provider Business Practice Location Address
First Line	:	1720 EL CAMINO REAL
Second Line	:	SUITE 130
City	:	BURLINGAME
State	:	CA
Zip	:	94010-3224
Country	:	US
Telephone Number	:	650-692-0977
Fax Number	:	650-259-5840

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2005
Last Update Date	:	07/08/2007

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