Provider Demographics
NPI:1255381901
Name:HSIEH, LISA LI (APRN)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:LI
Last Name:HSIEH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:MENG
Other - Middle Name:
Other - Last Name:LI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:819 W CESAR E CHAVEZ AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-2130
Mailing Address - Country:US
Mailing Address - Phone:213-613-1255
Mailing Address - Fax:
Practice Address - Street 1:819 W CESAR E CHAVEZ AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-2130
Practice Address - Country:US
Practice Address - Phone:213-613-1255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18640363LP2300X, 363LP2300X
MA246277363LF0000X
NH046557-23-03363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHP29078Medicare UPIN
NHNP3174Medicare ID - Type Unspecified
NHP29078Medicare UPIN