Provider Demographics
NPI:1457990194
Name:SCOFFIELD, LISA (IAYT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:SCOFFIELD
Suffix:
Gender:F
Credentials:IAYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11810 N TRACEY RD
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-9864
Mailing Address - Country:US
Mailing Address - Phone:208-659-2023
Mailing Address - Fax:
Practice Address - Street 1:11810 N TRACEY RD
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-9864
Practice Address - Country:US
Practice Address - Phone:208-659-2023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-28
Last Update Date:2019-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator