Provider Demographics
NPI:1770092801
Name:LISTER, DANIEL LEE
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:LEE
Last Name:LISTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-6139
Mailing Address - Country:US
Mailing Address - Phone:360-612-3839
Mailing Address - Fax:
Practice Address - Street 1:403 W STATE ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-6139
Practice Address - Country:US
Practice Address - Phone:360-612-3839
Practice Address - Fax:360-591-2246
Is Sole Proprietor?:No
Enumeration Date:2017-09-20
Last Update Date:2017-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist