Provider Demographics
NPI:1720325152
Name:MEYER-JONES, LISA R (RN IBCLC CLE LCCE)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:R
Last Name:MEYER-JONES
Suffix:
Gender:F
Credentials:RN IBCLC CLE LCCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 PINENUT CT
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-3544
Mailing Address - Country:US
Mailing Address - Phone:925-323-3925
Mailing Address - Fax:
Practice Address - Street 1:417 PINENUT CT
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-3544
Practice Address - Country:US
Practice Address - Phone:925-323-3925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA630037163WL0100X
DC12658174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No174H00000XOther Service ProvidersHealth Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA46-1683012OtherEIN