Healthcare Provider Details

I. General information

NPI: 1881889889
Provider Name (Legal Business Name): LISA LEIGHTON RN, PHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 09/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 SILVER AVE
SAN FRANCISCO CA
94134-1229
US

IV. Provider business mailing address

1525 SILVER AVE
SAN FRANCISCO CA
94134-1229
US

V. Phone/Fax

Practice location:
  • Phone: 415-657-1758
  • Fax: 415-657-1752
Mailing address:
  • Phone: 415-657-1758
  • Fax: 415-657-1752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number405163
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: