Clark, Lisa Diane

Clark, Lisa Diane is an individual health care provider with primary practice located at 265 N Broadway St , Portland OR 97227-1800. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Clark, Lisa Diane can be contacted via phone (503) 274-4885.

Contact Information

Primary practice address
265 N Broadway St Portland OR 97227-1800
Phone: (503) 274-4885
Fax: (503) 274-4814
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 200550098 Oregon

Profile Details

NPI number 1942276282
LBN Legal business name Clark, Lisa Diane
Credentials Family Nurse Practitioner (FNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 27th, 2006
Last updated Dec 22nd, 2011 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1942276282 NPPES
Oregon MEDICAID 273968
Oregon MEDICAID 1022791

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