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General NPI Number Information
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NPI Number | 1902975915
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Entity Type | Individual
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Provider Name | MRS. LISA D CREIGHTON
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Gender | Female
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 605 WOOD CREEK DR
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City | LYNDEN
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State | WA
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Zip | 98264-1107
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Country | US
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Telephone | 369-510-4432
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Fax | 360-318-0822
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Provider Business Mailing Address
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Address Line | 605 WOOD CREEK DR
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City | LYNDEN
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State | WA
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Zip | 98264-1107
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Country | US
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Telephone | 360-510-4432
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Fax | 360-318-0822
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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 | 156FX1800X
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Taxonomy Name | Optician
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License Number | DO00001440
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License Number State | WA
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