Individual
GLENN JOSEPH LYSACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1400 FARRAGUT AVE BLDG 940, BREMERTON, WA 98314-6001
(360) 476-6872
(360) 476-6872
Mailing address
1400 FARRAGUT AVE BLDG 940, BREMERTON, WA 98314-6001
(360) 476-6872
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA3242
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
292120100
—
FL
Enumeration date
06/04/2006
Last updated
08/14/2026
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