Provider Demographics
NPI:1588931240
Name:BRENNAN, LISA (ND)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 NE 117TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-5135
Mailing Address - Country:US
Mailing Address - Phone:206-632-0542
Mailing Address - Fax:206-633-5192
Practice Address - Street 1:12911 120TH AVE NE
Practice Address - Street 2:SUITE B10
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3027
Practice Address - Country:US
Practice Address - Phone:425-899-1234
Practice Address - Fax:425-828-3626
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-23
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANATU.NT.60344479175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2034989Medicaid