Individual
LISA J THACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C.
Contact information
Practice address
4190 E WOODMEN RD STE 100, COLORADO SPRINGS, CO 80920-8075
(719) 632-4455
(360) 462-5181
Mailing address
960 E GREEN ST, SUITE 292, PASADENA, CA 91106-2412
(626) 449-4494
(626) 449-4474
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA22118
CA
Other
Enumeration date
02/04/2009
Last updated
11/30/2022
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