Individual
LISA ANN VIDOVICH ROOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
720 WOOD ST, EUREKA, CA 95501-4413
(702) 268-2990
Mailing address
3075 FM 1844, GLADEWATER, TX 75647-5908
(530) 966-5747
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
95165375
CA
Other
Enumeration date
06/10/2025
Last updated
06/11/2025
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