MEDICARE: LISA BALLANTYNE ND, LMP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175F00000X	Naturopath	4725657-7100	UT
2	175F00000X	Naturopath	NT60799749	WA

General Provider Information

NPI Number	:	1225493174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA BALLANTYNE ND, LMP

Provider Business Mailing Address
First Line	:	3900 HARPER HILL RD SE
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-8931
Country	:	US
Telephone Number	:	801-712-2228
Fax Number	:

Provider Business Practice Location Address
First Line	:	3007 JUDSON ST
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-1219
Country	:	US
Telephone Number	:	253-777-3776
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2015
Last Update Date	:	07/08/2025

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