Provider Demographics
NPI:1073278172
Name:ZUKOWSKY, LISA (NTP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:ZUKOWSKY
Suffix:
Gender:F
Credentials:NTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2414 NE SUNNYMEDE ST
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-4516
Mailing Address - Country:US
Mailing Address - Phone:619-549-6517
Mailing Address - Fax:
Practice Address - Street 1:2414 NE SUNNYMEDE ST
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-4516
Practice Address - Country:US
Practice Address - Phone:619-549-6517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA