Active NPI
Lisa C Anderson, N.P.
- Nurse Practitioner
- Redlands, CA
National Provider Identifier
1003851593
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 11329
- Practice address
- 2 W Fern Ave
Redlands, CA 92373-5916 - Phone
- (909) 793-3311
- Fax
- (909) 796-4158
- NPI assigned
- Jun 18, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 11329 | CA | Primary |
Addresses
Primary practice location
2 W Fern Ave
Redlands, CA 92373-5916
Mailing address
PO Box 2200
Redlands, CA 92373-0722
Phone (909) 793-3311
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ZZZ20475Z | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11329 | CA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150588800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1295568000000",
"number": "1003851593",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2200",
"city": "REDLANDS",
"state": "CA",
"postal_code": "923730722",
"telephone_number": "909-793-3311",
"fax_number": "909-796-4158"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2 W FERN AVE",
"city": "REDLANDS",
"state": "CA",
"postal_code": "923735916",
"telephone_number": "909-793-3311",
"fax_number": "909-796-4158"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "LISA",
"middle_name": "C",
"name_prefix": "Mrs.",
"credential": "N.P.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-18",
"last_updated": "2011-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "CA",
"license": "11329",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "ZZZ20475Z",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Redlands, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.