Provider Demographics
NPI:1477820033
Name:HALE, LISA PUTNAM (RN, PNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:PUTNAM
Last Name:HALE
Suffix:
Gender:F
Credentials:RN, PNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:747 52ND STREET, HEMATOLOGY-ONCOLOGY DEPARTMENT
Mailing Address - Street 2:CHILDREN'S HOSPITAL & RESEARCH CENTER AT OAKLAND
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609
Mailing Address - Country:US
Mailing Address - Phone:510-428-3885
Mailing Address - Fax:510-597-7199
Practice Address - Street 1:747 52ND STREET, HEMATOLOGY-ONCOLOGY DEPARTMENT
Practice Address - Street 2:CHILDREN'S HOSPITAL & RESEARCH CENTER AT OAKLAND
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609
Practice Address - Country:US
Practice Address - Phone:510-428-3885
Practice Address - Fax:510-597-7199
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA732596163W00000X
CA21022363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
20113310OtherNATIONAL PNP CERTIFICATION PEDIATRIC NURSING CERT BOARD