Provider Demographics
NPI:1265859441
Name:HESCOCK, LISA BUCK (LMT)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:BUCK
Last Name:HESCOCK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31044 LANES TURN RD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97408-9413
Mailing Address - Country:US
Mailing Address - Phone:541-729-6721
Mailing Address - Fax:
Practice Address - Street 1:31044 LANES TURN RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97408-9413
Practice Address - Country:US
Practice Address - Phone:541-729-6721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-25
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8143247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other