Provider Demographics
NPI:1932772407
Name:TRIBBY-HIGH, LISA MARIE (RN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:TRIBBY-HIGH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 155
Mailing Address - Street 2:
Mailing Address - City:AHWAHNEE
Mailing Address - State:CA
Mailing Address - Zip Code:93601-0155
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:42888 HIGHWAY 49
Practice Address - Street 2:
Practice Address - City:AHWAHNEE
Practice Address - State:CA
Practice Address - Zip Code:93601-9719
Practice Address - Country:US
Practice Address - Phone:209-988-8259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA516646163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice