Provider Demographics
NPI:1801006770
Name:VANHAAGEN, LISA H (MS, LAC, LMT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:H
Last Name:VANHAAGEN
Suffix:
Gender:F
Credentials:MS, LAC, LMT
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 1321
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-6321
Mailing Address - Country:US
Mailing Address - Phone:360-708-6808
Mailing Address - Fax:360-588-1234
Practice Address - Street 1:700 MURDOCK ST
Practice Address - Street 2:
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284-1426
Practice Address - Country:US
Practice Address - Phone:360-708-6808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC2095171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist