Provider Demographics
NPI:1699194506
Name:RIBERAL, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:RIBERAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 MARINA VISTA DR # 86
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:OR
Mailing Address - Zip Code:97452-9751
Mailing Address - Country:US
Mailing Address - Phone:541-653-7736
Mailing Address - Fax:
Practice Address - Street 1:151 W 7TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-1100
Practice Address - Country:US
Practice Address - Phone:541-246-1557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-08
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201042338RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse