Healthcare Provider Details

I. General information

NPI: 1225136302
Provider Name (Legal Business Name): LISA JO LITTON CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 03/16/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 S 3RD ST
MOUNT VERNON WA
98273-4324
US

IV. Provider business mailing address

916 S 3RD ST
MOUNT VERNON WA
98273-4324
US

V. Phone/Fax

Practice location:
  • Phone: 360-336-5658
  • Fax: 360-336-5655
Mailing address:
  • Phone: 360-336-5658
  • Fax: 360-336-5655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00085617
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP30001593
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: