Organization
LISA KRISTINE NELSEN, MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LISA KRISTINE NELSEN MD (PRESIDENT)
(916) 652-6148
Entity
Organization
Contact information
Practice address
151 N SUNRISE AVE, SUITE 1107, ROSEVILLE, CA 95661-2924
(916) 780-1107
(916) 780-7007
Mailing address
3595 N LAKESHORE BLVD, LOOMIS, CA 95650-8500
(916) 652-6148
(916) 652-6138
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
A62910
CA
Other
Enumeration date
05/14/2007
Last updated
01/10/2013
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