Provider Demographics
NPI:1639627219
Name:BINGHAM, LISA CHRISTINE (NP-PP FAMILY)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:CHRISTINE
Last Name:BINGHAM
Suffix:
Gender:F
Credentials:NP-PP FAMILY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 SE BAKER ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-6038
Mailing Address - Country:US
Mailing Address - Phone:503-474-3600
Mailing Address - Fax:503-474-3601
Practice Address - Street 1:320 SE BAKER ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-6038
Practice Address - Country:US
Practice Address - Phone:503-474-3600
Practice Address - Fax:503-474-3601
Is Sole Proprietor?:No
Enumeration Date:2016-09-13
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR097000391RN163W00000X
OR202011304NP-PP363LP0808X
OR201708881NP-PP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR202011304NP-PPOtherOREGON LICENSE NUMBER
OR500734819Medicaid