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General NPI Number Information
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NPI Number | 1023031127
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Entity Type | Individual
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Provider Name | WALTER LYSINGER CRNA
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Gender | Male
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 02/07/2008
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Provider Practice Location Address
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Address Line | 591 GABRIEL AVE
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City | YUBA CITY
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State | CA
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Zip | 95993-8625
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Country | US
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Telephone | 530-673-2653
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Fax | 530-673-2653
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Provider Business Mailing Address
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Address Line | 591 GABRIEL AVE
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City | YUBA CITY
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State | CA
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Zip | 95993-8625
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Country | US
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Telephone | 530-673-2653
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Fax | 530-673-2653
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | RN3187510
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License Number State | CA
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