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Individual

LISA EDENS-TAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
ND

Contact information

Practice address
647 N MAIN ST, FORT BRAGG, CA 95437-3219
(925) 209-5966
Mailing address
623 S SANDERSON WAY, FORT BRAGG, CA 95437-4537
(925) 209-5966

Taxonomy

Speciality
Code
Description
License number
State
175F00000X
Naturopath
Primary
ND988
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
ND988
DEPARTMENT OF CONSUMER AFFAIRS
CA
Enumeration date
04/14/2018
Last updated
02/04/2020
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