Individual
LISA CAROL RIBERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1701 N 13TH ST, SHELTON, WA 98584-2077
(360) 426-2653
Mailing address
PO BOX 1668, SHELTON, WA 98584-5001
(360) 427-9549
(360) 462-2500
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA10005025
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8477416
—
WA
01
—
PA10005025
PA-C STATE LICENSE
WA
Enumeration date
01/02/2007
Last updated
06/06/2023
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