Healthcare Provider Details

I. General information

NPI: 1568686665
Provider Name (Legal Business Name): MEG LYSKAWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 89TH ST
DALY CITY CA
94015-1802
US

IV. Provider business mailing address

375 89TH ST
DALY CITY CA
94015-1802
US

V. Phone/Fax

Practice location:
  • Phone: 650-301-8649
  • Fax: 650-301-8639
Mailing address:
  • Phone: 650-301-8649
  • Fax: 650-301-8639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number528585
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: