Provider Demographics
NPI:1942454327
Name:NANCE, LISA LOUISE (ADULT NP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:LOUISE
Last Name:NANCE
Suffix:
Gender:F
Credentials:ADULT NP
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3203 SE WOODSTOCK BLVD
Mailing Address - Street 2:REED COLLEGE STUDENT HEALTH & COUNSELING CENTER
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-8199
Mailing Address - Country:US
Mailing Address - Phone:503-777-7281
Mailing Address - Fax:
Practice Address - Street 1:3203 SE WOODSTOCK BLVD
Practice Address - Street 2:REED COLLEGE STUDENT HEALTH & COUNSELING CENTER
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-8138
Practice Address - Country:US
Practice Address - Phone:503-777-7281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR091006214N3363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR091006214N3OtherOR STATE BOARD NURSING