Healthcare Provider Details

I. General information

NPI: 1013072859
Provider Name (Legal Business Name): LISA ELAINE BATCHELOR FNP, C, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23517 MAIN ST # 103
CARSON CA
90745-5251
US

IV. Provider business mailing address

1438 W 122ND ST
LOS ANGELES CA
90047-5309
US

V. Phone/Fax

Practice location:
  • Phone: 310-834-5388
  • Fax:
Mailing address:
  • Phone: 323-418-0804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP 15046
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: