Individual
LISA NICHOLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
200 MEDICAL PLAZA SUITE 265, LOS ANGELES, CA 90095
(310) 794-5066
Mailing address
5767 W CENTURY BLVD STE 400, LOS ANGELES, CA 90045-5631
Taxonomy
Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
Primary
17370
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
409782
CALIFORNIA BOARD OF REGIS
CA
Enumeration date
07/17/2007
Last updated
06/01/2018
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