Provider Demographics
NPI:1174659213
Name:WILLIAMSON, LISA JO (RN)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:JO
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 141932
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99514-1932
Mailing Address - Country:US
Mailing Address - Phone:907-729-0241
Mailing Address - Fax:
Practice Address - Street 1:1025 E 35TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4200
Practice Address - Country:US
Practice Address - Phone:907-729-0241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO93796163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse