Provider Demographics
NPI:1376905273
Name:DISANTE, LISA DAWN (BSN, RN, BC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:DAWN
Last Name:DISANTE
Suffix:
Gender:F
Credentials:BSN, RN, BC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:DAWN
Other - Last Name:ROBINSON GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1600 NW GARDEN VALLEY BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471
Mailing Address - Country:US
Mailing Address - Phone:541-440-3532
Mailing Address - Fax:541-440-3554
Practice Address - Street 1:2700 STEWART PARKWAY
Practice Address - Street 2:ANNEX B
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471
Practice Address - Country:US
Practice Address - Phone:541-440-3532
Practice Address - Fax:541-440-3554
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker