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General NPI Number Information
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NPI Number | 1821176058
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Entity Type | Individual
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Provider Name | LISA PATRICIA PEPPERDINE ARNP
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Gender | Female
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 813 MARTIN LUTHER KING JR WAY
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City | TACOMA
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State | WA
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Zip | 98405-4147
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Country | US
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Telephone | 253-779-3900
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Fax | 253-272-2718
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Provider Business Mailing Address
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Address Line | 15014 STARR RD SE
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City | OLALLA
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State | WA
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Zip | 98359-9537
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Country | US
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Telephone | 253-853-7873
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | AP30006753
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License Number State | WA
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