Provider Demographics
NPI:1609302348
Name:NEINCHEL, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:NEINCHEL
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 1:190 ROSE CT
Mailing Address - Street 2:APT 3
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-2894
Mailing Address - Country:US
Mailing Address - Phone:408-386-5225
Mailing Address - Fax:
Practice Address - Street 1:190 ROSE CT
Practice Address - Street 2:APT 3
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-2894
Practice Address - Country:US
Practice Address - Phone:408-386-5225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54108363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant