Provider Demographics
NPI:1730420134
Name:MARTIN, LISA MARIE (LAC, EAMP, AC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LAC, EAMP, AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5407 21ST AVENUE CT NE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98422-1959
Mailing Address - Country:US
Mailing Address - Phone:206-459-3704
Mailing Address - Fax:
Practice Address - Street 1:201 AUBURN WAY N STE A1
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-5062
Practice Address - Country:US
Practice Address - Phone:252-394-1466
Practice Address - Fax:253-275-5047
Is Sole Proprietor?:No
Enumeration Date:2013-03-09
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60316469171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist