Provider Demographics
NPI:1841536729
Name:MARTIN, LISE (ARNP)
Entity type:Individual
Prefix:
First Name:LISE
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 N 130TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-7502
Mailing Address - Country:US
Mailing Address - Phone:206-485-4363
Mailing Address - Fax:877-540-0569
Practice Address - Street 1:925 N 130TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-7502
Practice Address - Country:US
Practice Address - Phone:206-485-4364
Practice Address - Fax:877-540-0569
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QH0100X
WAAP60321470363LF0000X, 163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1841536729OtherNPI
WA2024196Medicaid