Provider Demographics
NPI:1659434074
Name:SICHERMAN, LISA S (CPNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:S
Last Name:SICHERMAN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:GILLIAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 W EL MONTE WAY
Mailing Address - Street 2:
Mailing Address - City:DINUBA
Mailing Address - State:CA
Mailing Address - Zip Code:93618-1554
Mailing Address - Country:US
Mailing Address - Phone:559-595-9890
Mailing Address - Fax:559-353-7286
Practice Address - Street 1:9300 VALLEY CHILDRENS PL
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93638-8761
Practice Address - Country:US
Practice Address - Phone:559-353-7290
Practice Address - Fax:559-353-7286
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA503871163W00000X
CA13021363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1659434074OtherNPI