Provider Demographics
NPI:1902966732
Name:JORDAN, LISA (LAC, EAMP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LAC, EAMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9201 NAHAHUM CANYON RD
Mailing Address - Street 2:
Mailing Address - City:CASHMERE
Mailing Address - State:WA
Mailing Address - Zip Code:98815-9729
Mailing Address - Country:US
Mailing Address - Phone:425-467-9377
Mailing Address - Fax:
Practice Address - Street 1:101 COTTAGE AVE STE K
Practice Address - Street 2:
Practice Address - City:CASHMERE
Practice Address - State:WA
Practice Address - Zip Code:98815
Practice Address - Country:US
Practice Address - Phone:509-423-7095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00009146174400000X
WAAC60726288171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1902966732OtherACUPUNCTURE