Lisa Birley, PAC

Individual provider Active NPI Physician Assistant · Chehalis, WA

NPI 1831284058 · NPPES record last updated Dec 16, 2015

Key facts

NPI
1831284058
Entity type
Individual (NPI type 1)
Primary specialty
Physician Assistant 363A00000X
License
PA10004873 (WA)
Practice address
370 S Market Blvd
Chehalis Childrens Clinic
Chehalis, WA 98532
Phone
(360) 748-6693
Fax
(360) 748-3619
NPI assigned
Oct 4, 2006
Sex
Female
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA10004873WAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services Washington Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA10004873 WA Yes

Addresses

Primary practice location

370 S Market Blvd
Chehalis Childrens Clinic
Chehalis, WA 98532

Mailing address

370 S Market Blvd
Chehalis, WA 98532
Phone (360) 748-6693

Other providers in Chehalis, WA

All providers in Chehalis, WA · Physician Assistant in Washington

Sources for this page

Verify at the official NPI Registry.