Individual
MS. LISA MARIE REARDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4008 W 27TH AVE, SUITE 103, KENNEWICK, WA 99337
(509) 942-2355
(509) 222-1289
Mailing address
560 GAGE BLVD, SUITE 203, RICHLAND, WA 99352
(509) 942-3627
(509) 942-2268
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
PA00739
OR
363AM0700X
Medical Physician Assistant
Primary
PA60423341
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1700049228
—
WA
Enumeration date
07/03/2008
Last updated
11/17/2016
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