Provider Demographics
NPI:1720136997
Name:FLOWERS, LISA MARINA (LICENSED VOCATIONAL)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARINA
Last Name:FLOWERS
Suffix:
Gender:F
Credentials:LICENSED VOCATIONAL
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARINA
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICENSE VOCATIONAL N
Mailing Address - Street 1:5769 W EL PASO AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-2286
Mailing Address - Country:US
Mailing Address - Phone:559-895-2923
Mailing Address - Fax:
Practice Address - Street 1:5769 W EL PASO AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-2286
Practice Address - Country:US
Practice Address - Phone:559-895-2923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 203372164W00000X, 164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse