Provider Demographics
NPI:1871532176
Name:GARWOOD, LISA (PA-C)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:GARWOOD
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5900 BYRON CENTER AVE SW
Mailing Address - Street 2:MEDICAL ADMINISTRATION
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-9606
Mailing Address - Country:US
Mailing Address - Phone:616-252-3243
Mailing Address - Fax:616-252-0260
Practice Address - Street 1:4300 CASCADE RD SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546
Practice Address - Country:US
Practice Address - Phone:616-252-1500
Practice Address - Fax:616-252-1599
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2018-08-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601003132363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP43078Medicare UPIN