Healthcare Provider Details

I. General information

NPI: 1316240823
Provider Name (Legal Business Name): LISA POLLEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2010
Last Update Date: 12/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 BANCROFT WAY 1140
BERKELEY CA
94720-4301
US

IV. Provider business mailing address

2222 BANCROFT WAY 1140
BERKELEY CA
94720-4301
US

V. Phone/Fax

Practice location:
  • Phone: 510-642-1297
  • Fax:
Mailing address:
  • Phone: 510-642-1297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1400X
TaxonomyCollege Health Registered Nurse
License NumberRN355630
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: