Provider Demographics
NPI:1811207913
Name:STEVENS, LISA (PA-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:330 S GARDEN WAY
Mailing Address - Street 2:STE 390
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-8179
Mailing Address - Country:US
Mailing Address - Phone:541-334-3350
Mailing Address - Fax:541-284-5198
Practice Address - Street 1:2400 HARTMAN LN
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-1118
Practice Address - Country:US
Practice Address - Phone:541-334-3350
Practice Address - Fax:541-284-5198
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORPA152783363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant