Healthcare Provider Details

I. General information

NPI: 1831714955
Provider Name (Legal Business Name): LISA NOVAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA BORDENKIRCHER

II. Dates (important events)

Enumeration Date: 06/15/2020
Last Update Date: 06/15/2020
Certification Date: 06/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1965 LIVE OAK BLVD
YUBA CITY CA
95991-8850
US

IV. Provider business mailing address

PO BOX 1077
YUBA CITY CA
95992-1077
US

V. Phone/Fax

Practice location:
  • Phone: 530-822-7200
  • Fax: 530-822-5061
Mailing address:
  • Phone: 530-635-3678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number727828
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: