Provider Demographics
NPI:1265674295
Name:CORSIE, LISA KRISTINE (ARNP)
Entity type:Individual
Prefix:MISS
First Name:LISA
Middle Name:KRISTINE
Last Name:CORSIE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 NAT WASHINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:WA
Mailing Address - Zip Code:98823-1982
Mailing Address - Country:US
Mailing Address - Phone:509-754-3330
Mailing Address - Fax:509-754-2351
Practice Address - Street 1:220 NAT WASHINGTON WAY
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:WA
Practice Address - Zip Code:98823-1982
Practice Address - Country:US
Practice Address - Phone:509-754-3330
Practice Address - Fax:509-754-2351
Is Sole Proprietor?:No
Enumeration Date:2009-04-06
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60037038363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9660952Medicaid
WA0247664OtherL & I
WA0247664OtherL & I