Provider Demographics
NPI:1568686665
Name:LYSKAWA, MEG
Entity Type:Individual
Prefix:
First Name:MEG
Middle Name:
Last Name:LYSKAWA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 89TH ST
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-1802
Mailing Address - Country:US
Mailing Address - Phone:650-301-8649
Mailing Address - Fax:650-301-8639
Practice Address - Street 1:375 89TH ST
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-1802
Practice Address - Country:US
Practice Address - Phone:650-301-8649
Practice Address - Fax:650-301-8639
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA528585163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health