Provider Demographics
NPI:1164964086
Name:ANDREWS, LISA JEWELL (NP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:JEWELL
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:DIANE
Other - Last Name:JEWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:690 GUZZI LN STE A
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5292
Mailing Address - Country:US
Mailing Address - Phone:209-536-5070
Mailing Address - Fax:
Practice Address - Street 1:690 GUZZI LN STE A
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5292
Practice Address - Country:US
Practice Address - Phone:209-536-5070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005420363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care