Individual
LIDIA WIERSUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2445 270TH AVE SE, ISSAQUAH, WA 98029-7901
(262) 748-5588
Mailing address
2445 270TH AVE SE, ISSAQUAH, WA 98029-7901
(262) 748-5588
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
AP60321256
WA
Other
Enumeration date
11/21/2012
Last updated
10/09/2020
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