MEDICARE: LISA KLEE MIHALY RN, FNP

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	603880	CA
2	363LF0000X	Family Nurse Practitioner	15201	CA

General Provider Information

NPI Number	:	1770508186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA KLEE MIHALY RN, FNP

Provider Business Mailing Address
First Line	:	280 CLIPPER ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94114-3819
Country	:	US
Telephone Number	:	415-269-0211
Fax Number	:

Provider Business Practice Location Address
First Line	:	1833 FILLMORE ST
Second Line	:	3RD FLOOR
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-3180
Country	:	US
Telephone Number	:	415-379-7800
Fax Number	:

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	03/31/2015

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