Basic Information
| Provider Information | |||||||||
| NPI: | 1821176058 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PEPPERDINE | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | PATRICIA | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15014 STARR RD SE | ||||||||
| Address2: | |||||||||
| City: | OLALLA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983599537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538537873 | ||||||||
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| Practice Location | |||||||||
| Address1: | 813 MARTIN LUTHER KING JR WAY | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984054147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2537793900 | ||||||||
| FaxNumber: | 2532722718 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | AP30006753 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
No ID Information.