Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist | STS 4427 | WA |
NPI | 1578511937 |
---|---|
Provider Name | Dr. Lisa G. Shaffer |
First Address | Spokane, WA 99204-2306 |
Second Address | Spokane, WA 99204-2306 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
93264 | AM. BOARD OF GENETICS (01) | CA |