MEDICARE: DENISE T LI NP

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
1	163W00000X	Registered Nurse	391756	CA
2	363L00000X	Nurse Practitioner	95001523	CA

General Provider Information

NPI Number	:	1245600774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE T LI NP

Provider Business Mailing Address
First Line	:	PO BOX 1452
Second Line	:
City	:	LAFAYETTE
State	:	CA
Zip	:	94549-1452
Country	:	US
Telephone Number	:	925-360-5835
Fax Number	:	925-462-7258

Provider Business Practice Location Address
First Line	:	3694 HAPPY VALLEY RD
Second Line	:
City	:	LAFAYETTE
State	:	CA
Zip	:	94549-3040
Country	:	US
Telephone Number	:	925-360-5835
Fax Number	:	925-462-7258

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2015
Last Update Date	:	09/27/2015

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Directions to “ DENISE T LI NP” Practice Location

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