MEDICARE: LISA MATTISON JONES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747A0650X	Attendant Care Provider

General Provider Information

NPI Number	:	1972215101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MATTISON JONES

Provider Business Mailing Address
First Line	:	4321 SW TRENTON ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98136-2452
Country	:	US
Telephone Number	:	206-790-7936
Fax Number	:

Provider Business Practice Location Address
First Line	:	4321 SW TRENTON ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98136-2452
Country	:	US
Telephone Number	:	206-790-7936
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2022
Last Update Date	:	12/19/2022

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