Provider Demographics
NPI:1689656928
Name:ASHLEY, LISA MARIE (RN, PNP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:MARIE
Last Name:ASHLEY
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Gender:F
Credentials:RN, PNP
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Mailing Address - Street 1:2516 STOCKTON BLVD
Mailing Address - Street 2:TICON LL
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2208
Mailing Address - Country:US
Mailing Address - Phone:916-734-7618
Mailing Address - Fax:916-734-7890
Practice Address - Street 1:2516 STOCKTON BLVD
Practice Address - Street 2:TICON LL
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2208
Practice Address - Country:US
Practice Address - Phone:916-734-7618
Practice Address - Fax:916-734-7890
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2011-11-30
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Provider Licenses
StateLicense IDTaxonomies
CAL297348363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS37973Medicare UPIN