Provider Demographics
NPI:1598088247
Name:LISSINA, OXANA P (LMP)
Entity Type:Individual
Prefix:MRS
First Name:OXANA
Middle Name:P
Last Name:LISSINA
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 1:16127 SE 256TH PL
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-4135
Mailing Address - Country:US
Mailing Address - Phone:206-407-5602
Mailing Address - Fax:
Practice Address - Street 1:16127 SE 256TH PL
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-4135
Practice Address - Country:US
Practice Address - Phone:206-407-5602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60129815174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist