Provider Demographics
NPI:1023243425
Name:FRITZER, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:FRITZER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:LATSCHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LDO
Mailing Address - Street 1:26240 TUCKERMAN AVE NE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:WA
Mailing Address - Zip Code:98346-9414
Mailing Address - Country:US
Mailing Address - Phone:360-621-2885
Mailing Address - Fax:360-297-2407
Practice Address - Street 1:26240 TUCKERMAN AVE NE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:WA
Practice Address - Zip Code:98346-9414
Practice Address - Country:US
Practice Address - Phone:360-621-2885
Practice Address - Fax:360-297-2407
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADO2162247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other