Provider Demographics
NPI:1518089424
Name:NOSTE, LISA ELIZABETH (LMP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ELIZABETH
Last Name:NOSTE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20825 BULSON RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274
Mailing Address - Country:US
Mailing Address - Phone:360-708-1467
Mailing Address - Fax:360-435-0234
Practice Address - Street 1:303 N OLYMPIC AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-1338
Practice Address - Country:US
Practice Address - Phone:360-708-1467
Practice Address - Fax:360-435-0234
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2015-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMAMA0018345225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist