Provider Demographics
NPI:1346363090
Name:DECAPUA, LISA (ND)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:DECAPUA
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6645 NE 78TH CT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97218-2827
Mailing Address - Country:US
Mailing Address - Phone:503-978-1100
Mailing Address - Fax:503-978-1119
Practice Address - Street 1:6645 NE 78TH CT STE C10
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97218-2827
Practice Address - Country:US
Practice Address - Phone:503-978-1100
Practice Address - Fax:503-978-1119
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1145175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath