Provider Demographics
NPI:1275065989
Name:DR. LISA M. NELSEN, PLLC
Entity Type:Organization
Organization Name:DR. LISA M. NELSEN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:F
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-676-4488
Mailing Address - Street 1:2029 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4233
Mailing Address - Country:US
Mailing Address - Phone:360-676-4488
Mailing Address - Fax:360-647-5587
Practice Address - Street 1:2029 JAMES ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4233
Practice Address - Country:US
Practice Address - Phone:360-676-4488
Practice Address - Fax:360-647-5587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002521111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA248270-001OtherKAISER PERMANENTE OF WASHINGTON
WA4542NEOtherBLUE CROSS/BLUE SHIELD
WA0074308OtherLABOR & INDUSTRIES OF WA
WAU20846Medicare UPIN