Provider Demographics
NPI:1265076129
Name:DUNN, LISA MARIE (LPN)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:DUNN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:SAJEC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:PO BOX 769
Mailing Address - Street 2:
Mailing Address - City:COSMOPOLIS
Mailing Address - State:WA
Mailing Address - Zip Code:98537-0769
Mailing Address - Country:US
Mailing Address - Phone:360-580-0459
Mailing Address - Fax:
Practice Address - Street 1:516 E 1ST ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-4106
Practice Address - Country:US
Practice Address - Phone:360-350-4010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-04
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00033395164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA33065255Medicaid