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NPI Code Detail

MEDICARE: LISA AN

MEDICARE: LISA AN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse95364553CA

General Provider Information

NPI Number : 1134009095
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA AN
Provider Business Mailing Address
First Line : 402 APPLE CREEK LN
Second Line :
City : SANTA ROSA
State : CA
Zip : 95401-6190
Country : US
Telephone Number : 916-305-0574
Fax Number :
Provider Business Practice Location Address
First Line : 1000 YULUPA AVE
Second Line :
City : SANTA ROSA
State : CA
Zip : 95405-7020
Country : US
Telephone Number : 916-305-0574
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/03/2025
Last Update Date : 10/24/2025

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Directions to “ LISA AN ” Practice Location

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