Provider Demographics
NPI:1154307163
Name:EASTON-HUMMEL, LISA A (ARNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:EASTON-HUMMEL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:A
Other - Last Name:HUMMEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:555 DAYTON ST STE A3
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-3647
Mailing Address - Country:US
Mailing Address - Phone:425-670-3710
Mailing Address - Fax:425-670-3711
Practice Address - Street 1:555 DAYTON ST STE A3
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-3647
Practice Address - Country:US
Practice Address - Phone:425-670-3710
Practice Address - Fax:425-670-3711
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30003284363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9615618Medicaid
WA9615618Medicaid
WA115126809Medicare ID - Type Unspecified