Provider Demographics
NPI:1285603803
Name:DRINKWATER, LISA KRISTINE (PA-C)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:KRISTINE
Last Name:DRINKWATER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9725 3RD AVE NE STE 500
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-2024
Mailing Address - Country:US
Mailing Address - Phone:206-527-1200
Mailing Address - Fax:206-527-2514
Practice Address - Street 1:9725 3RD AVE NE STE 500
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-2024
Practice Address - Country:US
Practice Address - Phone:206-527-1200
Practice Address - Fax:206-527-2514
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003673363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7110646Medicaid
WA7110646Medicaid
AB19813Medicare ID - Type Unspecified
WAGAB19813Medicare PIN
WAG8801827Medicare PIN