Provider Demographics
NPI:1912883281
Name:MCDONALD, LISA RENEE
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:RENEE
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 LEWELLING BLVD
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94580-1632
Mailing Address - Country:US
Mailing Address - Phone:510-606-2692
Mailing Address - Fax:
Practice Address - Street 1:268 LEWELLING BLVD
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:CA
Practice Address - Zip Code:94580-1632
Practice Address - Country:US
Practice Address - Phone:510-606-2692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA194215164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse