Provider Demographics
NPI:1912029836
Name:KISENWETHER, LISA K (FNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:K
Last Name:KISENWETHER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:KAY
Other - Last Name:KISENWETHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:801 SW 16TH ST
Mailing Address - Street 2:SUITE 121
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2697
Mailing Address - Country:US
Mailing Address - Phone:206-805-8885
Mailing Address - Fax:206-805-8886
Practice Address - Street 1:1414 N VERCLER RD
Practice Address - Street 2:SUITE B
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1092
Practice Address - Country:US
Practice Address - Phone:509-385-0302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007683363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner