Provider Demographics
NPI:1588380141
Name:DEYOUNG, LISA M (A-GNP-C)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:DEYOUNG
Suffix:
Gender:F
Credentials:A-GNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6002 WESTGATE BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-2572
Mailing Address - Country:US
Mailing Address - Phone:253-272-8664
Mailing Address - Fax:253-779-8364
Practice Address - Street 1:6002 WESTGATE BLVD STE 230
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-2572
Practice Address - Country:US
Practice Address - Phone:253-272-8664
Practice Address - Fax:253-779-8364
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAAP61371086363LG0600X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology