Provider Demographics
NPI:1669712238
Name:BARTHOLOMEW, LISA M (MPH, BS)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:BARTHOLOMEW
Suffix:
Gender:F
Credentials:MPH, BS
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:HIGGINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6020 35TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98126-3002
Mailing Address - Country:US
Mailing Address - Phone:206-461-6950
Mailing Address - Fax:206-782-8765
Practice Address - Street 1:6020 35TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126-3002
Practice Address - Country:US
Practice Address - Phone:206-461-6950
Practice Address - Fax:206-782-8765
Is Sole Proprietor?:No
Enumeration Date:2013-02-19
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60311993133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist