Healthcare Provider Details

I. General information

NPI: 1922247196
Provider Name (Legal Business Name): LISA COLLEEN BURCHETT LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2009
Last Update Date: 02/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 W JACKMAN
LANCASTER CA
93534
US

IV. Provider business mailing address

3400 15TH ST W APT 11
ROSAMOND CA
93560-7340
US

V. Phone/Fax

Practice location:
  • Phone: 661-726-2850
  • Fax:
Mailing address:
  • Phone: 661-350-8301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN235054
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: