Healthcare Provider Details

I. General information

NPI: 1447363791
Provider Name (Legal Business Name): LISA LYNN GASKIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FOURTH STREET BLDG 166
FORT IRWIN CA
92310
US

IV. Provider business mailing address

FOURTH STREET BLDG 166
FORT IRWIN CA
92310
US

V. Phone/Fax

Practice location:
  • Phone: 760-380-3199
  • Fax:
Mailing address:
  • Phone: 760-380-3199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number0001175531
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: