Provider Demographics
NPI:1114508868
Name:KAUTZMAN, LISA L (RN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:L
Last Name:KAUTZMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:KAUTZMAN
Other - Last Name:TOOHEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:18700 MADRONA DR
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-3854
Mailing Address - Country:US
Mailing Address - Phone:503-616-6918
Mailing Address - Fax:
Practice Address - Street 1:7320 SW HUNZIKER RD STE 300
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-2302
Practice Address - Country:US
Practice Address - Phone:503-941-3033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201402043RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse