Provider Demographics
NPI:1134696685
Name:MCINTIRE, LISA ADAMS (RN)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ADAMS
Last Name:MCINTIRE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:JEAN
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:7177 BRYDON RD
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-1112
Mailing Address - Country:US
Mailing Address - Phone:909-596-0550
Mailing Address - Fax:
Practice Address - Street 1:880 S LEMON AVE
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-2931
Practice Address - Country:US
Practice Address - Phone:909-595-1261
Practice Address - Fax:909-839-1212
Is Sole Proprietor?:No
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA305448163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool