Provider Demographics
NPI:1265552855
Name:PHILLIPS, LISA ANN (CAS)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 JOINER PKWY APT 32
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-2338
Mailing Address - Country:US
Mailing Address - Phone:916-645-2031
Mailing Address - Fax:
Practice Address - Street 1:199 HOFFMAN AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-4209
Practice Address - Country:US
Practice Address - Phone:530-885-9067
Practice Address - Fax:530-885-2534
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist