Lisa Iwanyczko, LVN

Primary specialty

Licensed Vocational NurseTaxonomy code 164X00000X

License

270176 Issued in CA

Practice address

8946 Madison Ave
Fair Oaks, CA 95628-4010

Phone

(916) 438-9569

NPI assigned

May 26, 2020

Last updated

May 26, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1590451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590451200000",
    "number": "1790308799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9032 HAVERING DR",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "957479598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8946 MADISON AVE",
            "city": "FAIR OAKS",
            "state": "CA",
            "postal_code": "956284010",
            "telephone_number": "916-438-9569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IWANYCZKO",
        "first_name": "LISA",
        "credential": "LVN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-05-26",
        "last_updated": "2020-05-26",
        "certification_date": "2020-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "CA",
            "license": "270176",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lisai@cleanandsoberdetox.com",
            "affiliation": "N",
            "address_1": "8946 Madison Ave",
            "city": "Fair Oaks",
            "state": "CA",
            "country_code": "US",
            "postal_code": "956284010",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Licensed Vocational Nurse in Fair Oaks, CA
• Providers in Fair Oaks, CA by specialty
• Licensed Vocational Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.