Provider Demographics
NPI:1881318863
Name:TATA-ACHA, ELIZABETH LEMFEYIN WISIY (NP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LEMFEYIN WISIY
Last Name:TATA-ACHA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 NORTH SAN VINCENTE BOULEVARD SUITE 268
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2329
Mailing Address - Country:US
Mailing Address - Phone:818-900-3573
Mailing Address - Fax:
Practice Address - Street 1:113 N SAN VICENTE BLVD STE 268
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2329
Practice Address - Country:US
Practice Address - Phone:747-732-4549
Practice Address - Fax:747-237-3305
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95021283363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health