Provider Demographics
NPI:1114263407
Name:AASA, ANNA MAJ-LIS (RN)
Entity Type:Individual
Prefix:
First Name:ANNA MAJ-LIS
Middle Name:
Last Name:AASA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1534 N MOORPARK RD # 101
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-5129
Mailing Address - Country:US
Mailing Address - Phone:310-971-8171
Mailing Address - Fax:805-876-0033
Practice Address - Street 1:1629 220TH ST SE STE 201
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-8466
Practice Address - Country:US
Practice Address - Phone:425-486-1000
Practice Address - Fax:425-939-5220
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-14
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN 00095547163WP0000X
CA440092163WP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0000XNursing Service ProvidersRegistered NursePain Management