Provider Demographics
NPI:1780889675
Name:BEARD, LISA LYNN (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:LYNN
Last Name:BEARD
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4741 MOORPARK WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95842-3146
Mailing Address - Country:US
Mailing Address - Phone:916-332-3459
Mailing Address - Fax:
Practice Address - Street 1:4741 MOORPARK WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95842-3146
Practice Address - Country:US
Practice Address - Phone:916-332-3459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA603531163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEPS015840Medicaid
CARVN004060Medicaid