Provider Demographics
NPI:1871736652
Name:STILL, LISA MARIE (RDMS)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:STILL
Suffix:
Gender:F
Credentials:RDMS
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:FULTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5601 32ND AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98126-2915
Mailing Address - Country:US
Mailing Address - Phone:206-938-7922
Mailing Address - Fax:206-299-3651
Practice Address - Street 1:5601 32ND AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126-2915
Practice Address - Country:US
Practice Address - Phone:206-938-7922
Practice Address - Fax:206-299-3651
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-09
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7142177Medicaid
WAG8867947Medicare PIN