Provider Demographics
NPI:1760439079
Name:HARRISON, LISA MARIE (CRNA)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:MARIE
Last Name:HARRISON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:SMALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:2211 NE 139TH ST
Mailing Address - Street 2:ROOM 2C117
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-2742
Mailing Address - Country:US
Mailing Address - Phone:360-487-2500
Mailing Address - Fax:369-487-2539
Practice Address - Street 1:2211 NE 139TH ST
Practice Address - Street 2:ROOM 2C117
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-2742
Practice Address - Country:US
Practice Address - Phone:360-487-2500
Practice Address - Fax:369-487-2539
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006523367500000X
FLAPRN11007322367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
8854780Medicare ID - Type Unspecified