Individual
MS. LISA A. RENSBERGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
751 NE BLAKELY DR STE 3020, ISSAQUAH, WA 98029
(425) 313-5345
(425) 313-4704
Mailing address
PO BOX 25608, SALT LAKE CITY, UT 84125-0608
(206) 320-4476
(206) 568-7043
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10004503
WA
363AM0700X
Medical Physician Assistant
PA10004503
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5366RE
BLUE SHIELD #
WA
05
—
8450686
—
WA
01
—
P00396760
RAILROAD MC #
WA
Enumeration date
05/18/2006
Last updated
06/24/2021
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