Provider Demographics
NPI:1831284058
Name:BIRLEY, LISA (PAC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:BIRLEY
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:370 S MARKET BLVD
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532
Mailing Address - Country:US
Mailing Address - Phone:360-748-6693
Mailing Address - Fax:360-748-3619
Practice Address - Street 1:370 S MARKET BLVD
Practice Address - Street 2:CHEHALIS CHILDRENS CLINIC
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532
Practice Address - Country:US
Practice Address - Phone:360-748-6693
Practice Address - Fax:360-748-3619
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004873363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant