Provider Demographics
NPI:1821176058
Name:PEPPERDINE, LISA PATRICIA (ARNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:PATRICIA
Last Name:PEPPERDINE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15014 STARR RD SE
Mailing Address - Street 2:
Mailing Address - City:OLALLA
Mailing Address - State:WA
Mailing Address - Zip Code:98359-9537
Mailing Address - Country:US
Mailing Address - Phone:253-853-7873
Mailing Address - Fax:
Practice Address - Street 1:813 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4147
Practice Address - Country:US
Practice Address - Phone:253-779-3900
Practice Address - Fax:253-272-2718
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006753363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health