Provider Demographics
NPI:1649239690
Name:HENN, LISA ANN (PA)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANN
Last Name:HENN
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:3082 MCMURRAY DR
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:CA
Mailing Address - Zip Code:96007-3544
Mailing Address - Country:US
Mailing Address - Phone:530-365-4420
Mailing Address - Fax:530-365-5186
Practice Address - Street 1:3082 MCMURRAY DR
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:CA
Practice Address - Zip Code:96007-3544
Practice Address - Country:US
Practice Address - Phone:530-365-4420
Practice Address - Fax:530-365-5186
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA01859363AM0700X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ47022Medicare UPIN