Lisa M Coonrod, RN, BSN
Individual provider Active NPI Registered Nurse · Mentone, CA
NPI 1356530786 · NPPES record last updated Oct 22, 2007
Key facts
- NPI
- 1356530786
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 473901 (CA)
- Practice address
- 34452 Fish Hatchery Rd
Mentone, CA 92359-0122 - Phone
- (909) 794-1743
- NPI assigned
- Oct 22, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Bachelor on Science - Nursing, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 473901 | CA | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 473901 | CA | Yes |
Addresses
Primary practice location
34452 Fish Hatchery Rd
Mentone, CA 92359-0122
Mailing address
PO Box 122
Mentone, CA 92359-0122
Phone (909) 794-1743
Other providers in Mentone, CA
- Building a Generation
- Jackie Ann Burman-Solgan
- Rachel Cabuhat
- Yaritza Camacho
- Tina Marie Carrillo
- Covenant Health Services
- Ian Terry Crocker
- Maria Rosario Cruz Heredia
- Mohamed M Elhanafy
- Lara Elijah
All providers in Mentone, CA · Registered Nurse in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 22, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.