Healthcare Provider Details

I. General information

NPI: 1720325152
Provider Name (Legal Business Name): LISA R MEYER-JONES RN IBCLC CLE LCCE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2013
Last Update Date: 01/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 PINENUT CT
SAN RAMON CA
94583-3544
US

IV. Provider business mailing address

417 PINENUT CT
SAN RAMON CA
94583-3544
US

V. Phone/Fax

Practice location:
  • Phone: 925-323-3925
  • Fax:
Mailing address:
  • Phone: 925-323-3925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number630037
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number12658
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: