Provider Demographics
NPI:1720274459
Name:BARNES, LISA C (ARNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:C
Last Name:BARNES
Suffix:
Gender:F
Credentials:ARNP
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Mailing Address - Street 1:GARFIELD COUNTY PUBLIC HOSPITAL DISTRICT #1
Mailing Address - Street 2:66 N. SIXTH ST.
Mailing Address - City:POMEROY
Mailing Address - State:WA
Mailing Address - Zip Code:99347-9705
Mailing Address - Country:US
Mailing Address - Phone:509-843-1591
Mailing Address - Fax:509-843-1234
Practice Address - Street 1:446 PATAHA ST.
Practice Address - Street 2:POMEROY MEDICAL CLINIC
Practice Address - City:POMEROY
Practice Address - State:WA
Practice Address - Zip Code:99347
Practice Address - Country:US
Practice Address - Phone:509-843-1491
Practice Address - Fax:509-843-1740
Is Sole Proprietor?:No
Enumeration Date:2007-09-17
Last Update Date:2010-03-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAAP30007819363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807849100OtherSTATE OF IDAHO MEDICAID
WA8945416OtherL&I