Healthcare Provider Details

I. General information

NPI: 1407014749
Provider Name (Legal Business Name): LISA B NEAL ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 12/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 LILLY RD NE
OLYMPIA WA
98506-5133
US

IV. Provider business mailing address

PO BOX 3505
PORTLAND OR
97208-3505
US

V. Phone/Fax

Practice location:
  • Phone: 360-486-6147
  • Fax: 360-486-6447
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN00127782
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP 60662300
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: