Individual
LISA MICHELLE MATIACO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
10 ROS CIR, REPUBLIC, WA 99166-5002
(509) 775-3153
(509) 775-8929
Mailing address
10 ROS CIR, REPUBLIC, WA 99166-5002
(509) 775-3153
(509) 775-8929
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
11/01/2007
Last updated
03/21/2013
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