Provider Demographics
NPI:1861486359
Name:FREY, LISA A (NP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:A
Last Name:FREY
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:305 SEQUOIA AVE
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-3426
Mailing Address - Country:US
Mailing Address - Phone:650-365-3464
Mailing Address - Fax:650-365-3464
Practice Address - Street 1:1720 EL CAMINO REAL
Practice Address - Street 2:SUITE 130
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3224
Practice Address - Country:US
Practice Address - Phone:650-692-0977
Practice Address - Fax:650-259-5840
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-10
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA397488363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP24864Medicare UPIN