Provider Demographics
NPI:1568426955
Name:THOMASSEN, LISA VEVA (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:VEVA
Last Name:THOMASSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100559
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-0559
Mailing Address - Country:US
Mailing Address - Phone:843-664-4300
Mailing Address - Fax:843-664-4308
Practice Address - Street 1:1280 116TH AVE NE
Practice Address - Street 2:SUITE 210
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3803
Practice Address - Country:US
Practice Address - Phone:425-646-0922
Practice Address - Fax:425-646-0925
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00033985207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8212615Medicaid
WAGAB01629Medicare PIN
WAGAB01628Medicare PIN
WAGAB01630Medicare PIN
WAGAB01631Medicare PIN
WA8212615Medicaid