Provider Demographics
NPI:1396133708
Name:HARLOW, LISA ANNE (LVN)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANNE
Last Name:HARLOW
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38647 PINON PINE TRL
Mailing Address - Street 2:
Mailing Address - City:BOULEVARD
Mailing Address - State:CA
Mailing Address - Zip Code:91905-9690
Mailing Address - Country:US
Mailing Address - Phone:619-417-4494
Mailing Address - Fax:
Practice Address - Street 1:38647 PINON PINE TRL
Practice Address - Street 2:
Practice Address - City:BOULEVARD
Practice Address - State:CA
Practice Address - Zip Code:91905-9690
Practice Address - Country:US
Practice Address - Phone:619-417-4494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN282199164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse