Provider Demographics
NPI:1912523754
Name:GOLDEN, LISA A
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:A
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1401 NW 46TH ST FL 5
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-4625
Mailing Address - Country:US
Mailing Address - Phone:206-297-5360
Mailing Address - Fax:877-514-5831
Practice Address - Street 1:1401 NW 46TH ST FL 5
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-4625
Practice Address - Country:US
Practice Address - Phone:206-297-5360
Practice Address - Fax:877-514-5831
Is Sole Proprietor?:No
Enumeration Date:2020-06-17
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61400312207Q00000X
PAMT219857390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program