Provider Demographics
NPI:1598385106
Name:PAOLUCCI-MONTELEONE, LISA (RN CDE)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:PAOLUCCI-MONTELEONE
Suffix:
Gender:F
Credentials:RN CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1669
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93232-1669
Mailing Address - Country:US
Mailing Address - Phone:559-587-1100
Mailing Address - Fax:
Practice Address - Street 1:515 W GRANGEVILLE BLVD
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-2861
Practice Address - Country:US
Practice Address - Phone:928-247-7309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-23
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3356661OtherCALIFORNIA BOARD OF REGISTERED NURSING
08620855OtherNCBDE