Provider Demographics
NPI:1528153418
Name:STEFFENSEN-GAMRATH, LISA MARIE (DO)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:STEFFENSEN-GAMRATH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4122 FACTORIA BLVD SE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-4200
Mailing Address - Country:US
Mailing Address - Phone:425-865-8080
Mailing Address - Fax:425-865-0977
Practice Address - Street 1:4122 FACTORIA BLVD SE
Practice Address - Street 2:SUITE 201
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-4200
Practice Address - Country:US
Practice Address - Phone:425-865-8080
Practice Address - Fax:425-865-0977
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001104207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAD33719Medicare UPIN