Healthcare Provider Details

I. General information

NPI: 1780889675
Provider Name (Legal Business Name): LISA LYNN BEARD REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4741 MOORPARK WAY
SACRAMENTO CA
95842-3146
US

IV. Provider business mailing address

4741 MOORPARK WAY
SACRAMENTO CA
95842-3146
US

V. Phone/Fax

Practice location:
  • Phone: 916-332-3459
  • Fax:
Mailing address:
  • Phone: 916-332-3459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number603531
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: