Provider Demographics
NPI:1114697349
Name:WHEELER-HAGGART, LISA (DNP, CRNA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:WHEELER-HAGGART
Suffix:
Gender:F
Credentials:DNP, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25901 PORTOFINO UNIT 179
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-4548
Mailing Address - Country:US
Mailing Address - Phone:503-539-7578
Mailing Address - Fax:
Practice Address - Street 1:40740 CALIFORNIA OAKS RD
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5727
Practice Address - Country:US
Practice Address - Phone:951-304-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-19
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPROCESSING367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered