Provider Demographics
NPI:1437517349
Name:LAKICH, ELYSSA (FNP)
Entity Type:Individual
Prefix:
First Name:ELYSSA
Middle Name:
Last Name:LAKICH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6220 BELLEAU WOOD LN STE 4
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822-5922
Mailing Address - Country:US
Mailing Address - Phone:916-633-1367
Mailing Address - Fax:
Practice Address - Street 1:6220 BELLEAU WOOD LN STE 4
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95822-5922
Practice Address - Country:US
Practice Address - Phone:916-633-1367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-05
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA707143363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily