Provider Demographics
NPI:1962125849
Name:RODRIGUEZ, LISA KRISTI (DNP-PMHNP)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:KRISTI
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:DNP-PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7120 248TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98053-8674
Mailing Address - Country:US
Mailing Address - Phone:503-510-4108
Mailing Address - Fax:
Practice Address - Street 1:7120 248TH AVE NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98053-8674
Practice Address - Country:US
Practice Address - Phone:503-510-4108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61345926363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health