Provider Demographics
NPI:1922177674
Name:MCKINNON, LISBETH M (MD)
Entity Type:Individual
Prefix:DR
First Name:LISBETH
Middle Name:M
Last Name:MCKINNON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LISBETH
Other - Middle Name:M
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1035 116TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-4604
Mailing Address - Country:US
Mailing Address - Phone:206-363-2800
Mailing Address - Fax:
Practice Address - Street 1:1560 N 115TH ST
Practice Address - Street 2:212
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133
Practice Address - Country:US
Practice Address - Phone:206-363-2800
Practice Address - Fax:206-363-2811
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00036374207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology