Healthcare Provider Details

I. General information

NPI: 1538495254
Provider Name (Legal Business Name): LISA SAMBATARO RUSH RN, BSN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2009
Last Update Date: 10/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8115 4TH AVE SW
SEATTLE WA
98106-2153
US

IV. Provider business mailing address

8520 218TH ST SW
EDMONDS WA
98026-7859
US

V. Phone/Fax

Practice location:
  • Phone: 296-763-2733
  • Fax: 206-762-0746
Mailing address:
  • Phone: 425-967-5887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00134333
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number10726459
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: