Provider Demographics
NPI:1134103625
Name:ADAMEK, LISA M (NP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:ADAMEK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 HORSESHOE BAR RD # A243
Mailing Address - Street 2:
Mailing Address - City:LOOMIS
Mailing Address - State:CA
Mailing Address - Zip Code:95650-8537
Mailing Address - Country:US
Mailing Address - Phone:916-581-1387
Mailing Address - Fax:
Practice Address - Street 1:3017 DOUGLAS BLVD STE 300
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3850
Practice Address - Country:US
Practice Address - Phone:916-581-1387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA569099363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ24070ZMedicare PIN
P66476Medicare UPIN