Healthcare Provider Details

I. General information

NPI: 1376882589
Provider Name (Legal Business Name): LISA ANN NEDLAN R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2013
Last Update Date: 02/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6442 ELK RIVER RD
EUREKA CA
95503-9607
US

IV. Provider business mailing address

6442 ELK RIVER RD
EUREKA CA
95503-9607
US

V. Phone/Fax

Practice location:
  • Phone: 707-442-7312
  • Fax:
Mailing address:
  • Phone: 707-442-7312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number308613
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: