Provider Demographics
NPI:1437265550
Name:CRONIN, LISA A (ARNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:CRONIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 169TH ST S STE A
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-8242
Mailing Address - Country:US
Mailing Address - Phone:253-536-2824
Mailing Address - Fax:253-536-3070
Practice Address - Street 1:144 169TH ST S STE A
Practice Address - Street 2:
Practice Address - City:SPANAWAY
Practice Address - State:WA
Practice Address - Zip Code:98387-8242
Practice Address - Country:US
Practice Address - Phone:253-536-2824
Practice Address - Fax:253-536-3070
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005988163WG0000X, 164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Not Answered164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9643222Medicaid
WA9643222Medicaid