Healthcare Provider Details

I. General information

NPI: 1316211469
Provider Name (Legal Business Name): LISA LYNN VINAL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2012
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 E HILL AVE
MOSES LAKE WA
98837-2238
US

IV. Provider business mailing address

1831 SW HIGHWAY 101
LINCOLN CITY OR
97367-2356
US

V. Phone/Fax

Practice location:
  • Phone: 509-663-8711
  • Fax:
Mailing address:
  • Phone: 541-444-8341
  • Fax: 541-557-1714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA005724
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP.AP.61672200-NP
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: