Provider Demographics
NPI:1801124441
Name:BRISBINE, ELAINE S (LPN)
Entity type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:S
Last Name:BRISBINE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:S
Other - Last Name:DAVIS, TIPTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:58051 COLUMBIA RIVER HWY
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OR
Mailing Address - Zip Code:97053-9417
Mailing Address - Country:US
Mailing Address - Phone:503-396-2927
Mailing Address - Fax:
Practice Address - Street 1:58051 COLUMBIA RIVER HWY
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OR
Practice Address - Zip Code:97053-9417
Practice Address - Country:US
Practice Address - Phone:503-396-2927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200930418LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse