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General NPI Number Information
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NPI Number | 1578972543
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Entity Type | Individual
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Provider Name | LISA BURSCH NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 08/04/2014
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Last Update Date | 01/10/2019
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Provider Practice Location Address
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Address Line | 7777 MILLIKEN AVE STE 360
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-6782
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Country | US
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Telephone | 909-944-7099
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Fax |
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Provider Business Mailing Address
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Address Line | 41162 MESA ROBLES CIR
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City | TEMECULA
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State | CA
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Zip | 92592-9326
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Country | US
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Telephone | 951-313-7976
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Fax |
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 472262
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License Number State | CA
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