Provider Demographics
NPI:1851923320
Name:TEDFORD, LISA M (FNP-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:TEDFORD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 A ST
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-1635
Mailing Address - Country:US
Mailing Address - Phone:541-490-7267
Mailing Address - Fax:
Practice Address - Street 1:501 NE WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WHITE SALMON
Practice Address - State:WA
Practice Address - Zip Code:98672-1826
Practice Address - Country:US
Practice Address - Phone:509-493-1558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-12
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61041918363LF0000X
OR202003125NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily