Provider Demographics
NPI:1487667879
Name:SCHNACKENBERG, LISA JO (RN, MS, FNP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:JO
Last Name:SCHNACKENBERG
Suffix:
Gender:F
Credentials:RN, MS, FNP
Other - Prefix:MS
Other - First Name:'JOEY' (AKA)
Other - Middle Name:
Other - Last Name:SCHNACKENBERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, MS, FNP
Mailing Address - Street 1:9800 SE SUNNYSIDE RD
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-9750
Mailing Address - Country:US
Mailing Address - Phone:503-652-2880
Mailing Address - Fax:
Practice Address - Street 1:10180 SE SUNNYSIDE RD
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-8970
Practice Address - Country:US
Practice Address - Phone:503-652-2880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily