Healthcare Provider Details

I. General information

NPI: 1902966732
Provider Name (Legal Business Name): LISA JORDAN LAC., EAMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 02/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 COTTAGE AVE STE K
CASHMERE WA
98815
US

IV. Provider business mailing address

9201 NAHAHUM CANYON RD
CASHMERE WA
98815-9729
US

V. Phone/Fax

Practice location:
  • Phone: 509-423-7095
  • Fax:
Mailing address:
  • Phone: 425-467-9377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA00009146
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC60726288
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: