Provider Demographics
NPI:1487831244
Name:TRAN, LISA NGO (ARNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:NGO
Last Name:TRAN
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 1:1101 DEXTER AVE N SUITE 105
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109
Mailing Address - Country:US
Mailing Address - Phone:206-814-6533
Mailing Address - Fax:206-596-0821
Practice Address - Street 1:1101 DEXTER AVE N SUITE 105
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109
Practice Address - Country:US
Practice Address - Phone:206-814-6533
Practice Address - Fax:206-596-0821
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60315081363LF0000X
WARN00171208163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1487831244Medicaid