MEDICARE: ELIZABETH LEMFEYIN WISIY TATA-ACHA 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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	95021283	CA

General Provider Information

NPI Number	:	1881318863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH LEMFEYIN WISIY TATA-ACHA NP

Provider Business Mailing Address
First Line	:	113 NORTH SAN VINCENTE BOULEVARD SUITE 268
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-2329
Country	:	US
Telephone Number	:	818-900-3573
Fax Number	:

Provider Business Practice Location Address
First Line	:	113 N SAN VICENTE BLVD STE 268
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-2329
Country	:	US
Telephone Number	:	747-732-4549
Fax Number	:	747-237-3305

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

Provider Enumeration Date	:	10/03/2022
Last Update Date	:	11/09/2023

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