Healthcare Provider Details

I. General information

NPI: 1659434074
Provider Name (Legal Business Name): LISA S. SICHERMAN CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA GILLIAM

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 11/12/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 VALLEY CHILDRENS PL
MADERA CA
93638-8761
US

IV. Provider business mailing address

250 W EL MONTE WAY
DINUBA CA
93618-1554
US

V. Phone/Fax

Practice location:
  • Phone: 559-353-7290
  • Fax: 559-353-7286
Mailing address:
  • Phone: 559-595-9890
  • Fax: 559-353-7286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number503871
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number13021
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: