Provider Demographics
NPI:1821142738
Name:ZYLSTRA, LISA D (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:D
Last Name:ZYLSTRA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:DEKKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24015 NE W H GARNER RD
Mailing Address - Street 2:
Mailing Address - City:YACOLT
Mailing Address - State:WA
Mailing Address - Zip Code:98675-4303
Mailing Address - Country:US
Mailing Address - Phone:360-823-8084
Mailing Address - Fax:
Practice Address - Street 1:406 SE 131ST AVE STE C305
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-4004
Practice Address - Country:US
Practice Address - Phone:360-816-0277
Practice Address - Fax:360-567-4004
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004703363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical