Provider Demographics
NPI:1295857712
Name:BRITZ, LISA CHRISTINA (LMP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:CHRISTINA
Last Name:BRITZ
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:CHRISTINA
Other - Last Name:COLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:1302 S. 293 PL
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003
Mailing Address - Country:US
Mailing Address - Phone:425-825-0255
Mailing Address - Fax:425-821-8042
Practice Address - Street 1:11930 SLATER AVE NE
Practice Address - Street 2:#201
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-4175
Practice Address - Country:US
Practice Address - Phone:425-825-0255
Practice Address - Fax:425-821-8042
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00017196174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist