Healthcare Provider Details

I. General information

NPI: 1518184779
Provider Name (Legal Business Name): LISA GHILARDUCCI ROBERTS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 CONROY LN SUITE 301
ROSEVILLE CA
95661-4156
US

IV. Provider business mailing address

1900 LARKFLOWER WAY
LINCOLN CA
95648-3008
US

V. Phone/Fax

Practice location:
  • Phone: 916-784-6462
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN581130
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: