Healthcare Provider Details

I. General information

NPI: 1649239690
Provider Name (Legal Business Name): LISA ANN HENN P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 10/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3082 MCMURRAY DR
ANDERSON CA
96007-3544
US

IV. Provider business mailing address

3082 MCMURRAY DR
ANDERSON CA
96007-3544
US

V. Phone/Fax

Practice location:
  • Phone: 530-365-4420
  • Fax: 530-365-5186
Mailing address:
  • Phone: 530-365-4420
  • Fax: 530-365-5186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA01859
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: