Healthcare Provider Details

I. General information

NPI: 1134103625
Provider Name (Legal Business Name): LISA M ADAMEK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3017 DOUGLAS BLVD STE 300
ROSEVILLE CA
95661-3850
US

IV. Provider business mailing address

6100 HORSESHOE BAR RD # A243
LOOMIS CA
95650-8537
US

V. Phone/Fax

Practice location:
  • Phone: 916-581-1387
  • Fax:
Mailing address:
  • Phone: 916-581-1387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number569099
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: