Active NPI
Lisa Amanda Donaldson, ATC, MBA
- Athletic Trainer
- Costa Mesa, CA
National Provider Identifier
1568965994
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2000017880
- Practice address
- 2701 Fairview Rd
Costa Mesa, CA 92626-5563 - Phone
- (714) 559-0231
- NPI assigned
- Mar 12, 2018
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 2000017880 | WI | Primary |
Addresses
Primary practice location
2701 Fairview Rd
Costa Mesa, CA 92626-5563
Mailing address
9304 W Plainfield Ave
Greenfield, WI 53228-2118
Phone (414) 388-1918
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
- Master of Business Administration
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2000017880 | WI | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1520812800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1520812800000",
"number": "1568965994",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9304 W PLAINFIELD AVE",
"city": "GREENFIELD",
"state": "WI",
"postal_code": "532282118",
"telephone_number": "414-388-1918"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2701 FAIRVIEW RD",
"city": "COSTA MESA",
"state": "CA",
"postal_code": "926265563",
"telephone_number": "714-559-0231"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DONALDSON",
"first_name": "LISA",
"middle_name": "AMANDA",
"credential": "ATC, MBA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-03-12",
"last_updated": "2018-03-12",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "WI",
"license": "2000017880",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Costa Mesa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.