Healthcare Provider Details

I. General information

NPI: 1760439079
Provider Name (Legal Business Name): LISA MARIE HARRISON C.R.N.A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA MARIE SMALL C.R.N.A.

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 12/28/2022
Certification Date: 12/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 NE 139TH ST ROOM 2C117
VANCOUVER WA
98686-2742
US

IV. Provider business mailing address

2211 NE 139TH ST ROOM 2C117
VANCOUVER WA
98686-2742
US

V. Phone/Fax

Practice location:
  • Phone: 360-487-2500
  • Fax: 369-487-2539
Mailing address:
  • Phone: 360-487-2500
  • Fax: 369-487-2539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP30006523
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11007322
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: