Provider Demographics
NPI:1477631778
Name:ALDRICH, LISA (APRN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:ALDRICH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:MONDLICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1104 ADAMS ST 201
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENA
Mailing Address - State:CA
Mailing Address - Zip Code:94574-1175
Mailing Address - Country:US
Mailing Address - Phone:707-967-0800
Mailing Address - Fax:707-967-0870
Practice Address - Street 1:1104 ADAMS ST 201
Practice Address - Street 2:
Practice Address - City:SAINT HELENA
Practice Address - State:CA
Practice Address - Zip Code:94574-1175
Practice Address - Country:US
Practice Address - Phone:707-967-0800
Practice Address - Fax:707-967-0870
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP17643363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADG371ZMedicare UPIN
CTQ73183Medicare UPIN
CTC01373Medicare ID - Type UnspecifiedGHMC GROUP CARE ID
CT004264131Medicaid
CT004224846Medicaid