Provider Demographics
NPI:1982939385
Name:GARTIN, LISA (RN MSN CNM)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:GARTIN
Suffix:
Gender:F
Credentials:RN MSN CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3579 FRANKLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97403-2356
Mailing Address - Country:US
Mailing Address - Phone:541-344-9411
Mailing Address - Fax:
Practice Address - Street 1:3579 FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97403-2356
Practice Address - Country:US
Practice Address - Phone:541-344-9411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-02
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA493347163W00000X
CA235668367A00000X
NVAPRN002228367A00000X
374J00000X
OR202101553NP-PP367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
No374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR202101553NP-PPOtherOREGON LICENSE