Provider Demographics
NPI:1124338116
Name:BURKHOLDER, LISANNE RYNER (MD FACP FRACP)
Entity type:Individual
Prefix:DR
First Name:LISANNE
Middle Name:RYNER
Last Name:BURKHOLDER
Suffix:
Gender:F
Credentials:MD FACP FRACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10978 DONNER PASS RD
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-0433
Mailing Address - Country:US
Mailing Address - Phone:530-582-1212
Mailing Address - Fax:530-582-1171
Practice Address - Street 1:10978 DONNER PASS RD
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-0433
Practice Address - Country:US
Practice Address - Phone:530-582-1212
Practice Address - Fax:530-582-1171
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG84136207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine