Provider Demographics
NPI:1538495254
Name:RUSH, LISA SAMBATARO (RN, BSN, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:SAMBATARO
Last Name:RUSH
Suffix:
Gender:F
Credentials:RN, BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8520 218TH ST SW
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7859
Mailing Address - Country:US
Mailing Address - Phone:425-967-5887
Mailing Address - Fax:
Practice Address - Street 1:8115 4TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98106-2153
Practice Address - Country:US
Practice Address - Phone:296-763-2733
Practice Address - Fax:206-762-0746
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-30
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00134333163W00000X
WA10726459163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse