Provider Demographics
NPI:1376767277
Name:CATTERALL, LISA E (BSN, CNM)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:E
Last Name:CATTERALL
Suffix:
Gender:F
Credentials:BSN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 RALEY BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928
Mailing Address - Country:US
Mailing Address - Phone:530-345-4471
Mailing Address - Fax:530-345-4496
Practice Address - Street 1:111 RALEY BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928
Practice Address - Country:US
Practice Address - Phone:530-345-4471
Practice Address - Fax:530-345-4496
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN A0307966163W00000X
CACNM 408367A00000X
CA408367A00000X
CA307966163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANMW004080Medicaid
CAP90348Medicare UPIN
CAZZZ26285ZMedicare ID - Type Unspecified