Provider Demographics
NPI:1982700852
Name:NIGHTINGALE, LOIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:LOIS
Middle Name:
Last Name:NIGHTINGALE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LOIS
Other - Middle Name:
Other - Last Name:GOBRECHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:16960 E BASTANCHURY RD
Mailing Address - Street 2:STE J
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-1711
Mailing Address - Country:US
Mailing Address - Phone:714-993-5343
Mailing Address - Fax:
Practice Address - Street 1:16960 E BASTANCHURY RD
Practice Address - Street 2:STE J
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-1711
Practice Address - Country:US
Practice Address - Phone:714-993-5343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9503103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CP9503Medicare ID - Type Unspecified