Provider Demographics
NPI:1083746887
Name:ELVIN, LISA V (NP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:V
Last Name:ELVIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BON AIR RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LARKSPUR
Mailing Address - State:CA
Mailing Address - Zip Code:94939-1141
Mailing Address - Country:US
Mailing Address - Phone:415-927-5300
Mailing Address - Fax:415-927-5242
Practice Address - Street 1:2 BON AIR RD
Practice Address - Street 2:SUITE 120
Practice Address - City:LARKSPUR
Practice Address - State:CA
Practice Address - Zip Code:94939-1141
Practice Address - Country:US
Practice Address - Phone:415-927-5300
Practice Address - Fax:415-927-5242
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8864363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA382183OtherRN
CA8864OtherNP
CA8864OtherNP