Provider Demographics
NPI:1295986107
Name:MESEROLE, LISA P (ND, MS)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:P
Last Name:MESEROLE
Suffix:
Gender:F
Credentials:ND, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 899
Mailing Address - Street 2:
Mailing Address - City:COUPEVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98239-0899
Mailing Address - Country:US
Mailing Address - Phone:360-678-3581
Mailing Address - Fax:
Practice Address - Street 1:710 FT CASEY RD
Practice Address - Street 2:
Practice Address - City:COUPEVILLE
Practice Address - State:WA
Practice Address - Zip Code:98239-0899
Practice Address - Country:US
Practice Address - Phone:360-678-3581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA133N00000X
WANT00000650175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No133N00000XDietary & Nutritional Service ProvidersNutritionist