Individual
MS. LISA M HARTLEY
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
RN BSN CDE
Contact information
Practice address
681 MAIN ST, STE 100, PLACERVILLE, CA 95667-5736
(530) 626-2990
(530) 626-2992
Mailing address
1100 MARSHALL WAY, PLACERVILLE, CA 95667-6533
(530) 626-2990
(530) 626-2992
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
308969
CA
163WD0400X
Diabetes Educator Registered Nurse
Primary
20210187
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20210187
CDE
CA
01
—
308969
RN
CA
Enumeration date
12/19/2005
Last updated
09/11/2025
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