Healthcare Provider Details

I. General information

NPI: 1447886676
Provider Name (Legal Business Name): MRS. LISA MARIE WASHBURN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2020
Last Update Date: 03/19/2020
Certification Date: 03/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 BLAIRS FERRY RD NE STE 110
CEDAR RAPIDS IA
52402-1262
US

IV. Provider business mailing address

921 BLAIRS FERRY RD NE STE 110
CEDAR RAPIDS IA
52402-1262
US

V. Phone/Fax

Practice location:
  • Phone: 319-378-8077
  • Fax:
Mailing address:
  • Phone: 319-378-8077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number81663
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: