Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | AP60508972 | WA |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | AP60508972 | WA |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | AP60508972 | WA |
NPI | 1154723807 |
---|---|
Provider Name | Lisa M Austin |
First Address | Puyallup, WA 98372-3750 |
Second Address | Puyallup, WA 98372-3750 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2014 |
Last Update Date | 05/03/2015 |