Provider Demographics
NPI:1033376520
Name:RICHARDSON, LISA ANNETTE (LPN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANNETTE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23720 NE CANYON RD
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-9662
Mailing Address - Country:US
Mailing Address - Phone:360-431-6533
Mailing Address - Fax:
Practice Address - Street 1:23720 NE CANYON RD
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-9662
Practice Address - Country:US
Practice Address - Phone:360-431-6533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60259345163W00000X
NY289828164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse