Healthcare Provider Details

I. General information

NPI: 1811314677
Provider Name (Legal Business Name): LISA S BLISS MD PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2014
Last Update Date: 06/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15404 E SPRINGFIELD AVE SUITE L201
SPOKANE VALLEY WA
99037
US

IV. Provider business mailing address

15404 E SPRINGFIELD AVE SUITE L201
SPOKANE VALLEY WA
99037
US

V. Phone/Fax

Practice location:
  • Phone: 509-868-0938
  • Fax: 509-892-9998
Mailing address:
  • Phone: 509-868-0938
  • Fax: 509-892-9998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberMD00042250
License Number StateWA

VIII. Authorized Official

Name: LISA S BLISS
Title or Position: OWNER
Credential: MD
Phone: 509-868-0938