Healthcare Provider Details

I. General information

NPI: 1518648625
Provider Name (Legal Business Name): LISA MITSUE KUROBE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10022 43RD PL NE
SEATTLE WA
98125-8112
US

IV. Provider business mailing address

10022 43RD PL NE
SEATTLE WA
98125-8112
US

V. Phone/Fax

Practice location:
  • Phone: 207-841-9576
  • Fax:
Mailing address:
  • Phone: 207-841-9576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP.AP.70139266-NP
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: