Provider Demographics
NPI:1861476251
Name:CARLISLE, LYNDA LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:LYNDA
Middle Name:LEE
Last Name:CARLISLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4610 N VERDE ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98407-5113
Mailing Address - Country:US
Mailing Address - Phone:253-756-6823
Mailing Address - Fax:
Practice Address - Street 1:8805 STEILACOOM BLVD SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498-4770
Practice Address - Country:US
Practice Address - Phone:253-756-2688
Practice Address - Fax:253-756-3911
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000245822084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA00184983Medicare ID - Type Unspecified
G13559Medicare UPIN