Individual
MS. LISA GAIL WAHL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
420 GOLF CLUB RD SE, SUITE 204, LACEY, WA 98503-1048
(360) 493-7469
Mailing address
PO BOX 3360, PORTLAND, OR 97208-3360
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP30007766
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9654252
—
WA
01
—
AP30007766
WA LICENSE
WA
01
—
G8888381
MEDICARE
WA
Enumeration date
09/19/2007
Last updated
04/28/2021
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