Larsen, Tisha Marie

Larsen, Tisha Marie is an individual health care provider with primary practice located at 621 W Madrone St , Roseburg OR 97470-3090. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Family, Nursing Service Providers / Psychiatric/Mental Health, Adult. Nursing Service Providers / Psychiatric/Mental Health, Adult is her primary health care specialty. Larsen, Tisha Marie can be contacted via phone (541) 440-3500.

Contact Information

Primary practice address
621 W Madrone St Roseburg OR 97470-3090
Phone: (541) 440-3500
Fax: (541) 957-3003
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 201500780NP-PP Oregon
Nursing Service Providers / Psychiatric/Mental Health, Adult 163WP0809X 201910861NP-PP Oregon

Profile Details

NPI number 1578954855
LBN Legal business name Larsen, Tisha Marie
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 9th, 2015
Last updated Oct 12th, 2021 - about 3 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 1578954855 NPPES
Oregon MEDICAID 165772

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