Provider Demographics
NPI:1689202913
Name:HARPER, LISA JO
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:JO
Last Name:HARPER
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 1:5804 GARIBALDI ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95824-2724
Mailing Address - Country:US
Mailing Address - Phone:916-490-7157
Mailing Address - Fax:
Practice Address - Street 1:5804 GARIBALDI ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95824-2724
Practice Address - Country:US
Practice Address - Phone:916-490-7157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)