Provider Demographics
NPI:1538545132
Name:TOWNSEND, LISA K
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:K
Last Name:TOWNSEND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 WALKER AVE NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-4062
Mailing Address - Country:US
Mailing Address - Phone:616-328-4242
Mailing Address - Fax:
Practice Address - Street 1:1135 WALKER AVE NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-4062
Practice Address - Country:US
Practice Address - Phone:616-328-4242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL265059174400000X, 261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service