Provider Demographics
NPI:1376882589
Name:NEDLAN, LISA ANN (RN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:NEDLAN
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 1:6442 ELK RIVER RD
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-9607
Mailing Address - Country:US
Mailing Address - Phone:707-442-7312
Mailing Address - Fax:
Practice Address - Street 1:6442 ELK RIVER RD
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-9607
Practice Address - Country:US
Practice Address - Phone:707-442-7312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA308613163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care