Provider Demographics
NPI:1578511937
Name:SHAFFER, LISA G (PHD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:G
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:44 W 6TH AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2306
Mailing Address - Country:US
Mailing Address - Phone:509-474-6840
Mailing Address - Fax:
Practice Address - Street 1:44 W 6TH AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2306
Practice Address - Country:US
Practice Address - Phone:509-474-6840
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASTS 4427170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA93264OtherAM. BOARD OF GENETICS