Provider Demographics
NPI:1124894035
Name:HACKLER, LISA L (RN CWCN)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:L
Last Name:HACKLER
Suffix:
Gender:F
Credentials:RN CWCN
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:L
Other - Last Name:HACKLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN CWCN
Mailing Address - Street 1:12040 NE 128TH ST # MS 103
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3098
Mailing Address - Country:US
Mailing Address - Phone:425-899-3300
Mailing Address - Fax:425-899-3058
Practice Address - Street 1:12040 NE 128TH ST # MS 103
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3098
Practice Address - Country:US
Practice Address - Phone:425-899-3300
Practice Address - Fax:425-899-3058
Is Sole Proprietor?:No
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00082752163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health