Healthcare Provider Details

I. General information

NPI: 1427167394
Provider Name (Legal Business Name): LISA MAUREEN O'NEILL CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

598 WALNUT AVE
GREENFIELD CA
93927-4926
US

IV. Provider business mailing address

1691 THE ALAMEDA
SAN JOSE CA
95126-2203
US

V. Phone/Fax

Practice location:
  • Phone: 831-674-2200
  • Fax: 831-674-5812
Mailing address:
  • Phone: 408-287-7532
  • Fax: 408-287-0405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberNM 1437
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: