Provider Demographics
NPI:1366446270
Name:GIBBONS, LISA MICHELLE (DO)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MICHELLE
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14508 NE 20TH AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-6418
Mailing Address - Country:US
Mailing Address - Phone:360-433-0022
Mailing Address - Fax:360-433-6159
Practice Address - Street 1:14508 NE 20TH AVE
Practice Address - Street 2:STE 300
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-6418
Practice Address - Country:US
Practice Address - Phone:360-433-0022
Practice Address - Fax:360-433-6159
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAOP00001992207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology