Provider Demographics
NPI:1982993978
Name:WARD, LISA ANN
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANN
Last Name:WARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:WALTERVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97489-0099
Mailing Address - Country:US
Mailing Address - Phone:541-896-3358
Mailing Address - Fax:541-896-3358
Practice Address - Street 1:89926 GREENWOOD DR
Practice Address - Street 2:
Practice Address - City:LEABURG
Practice Address - State:OR
Practice Address - Zip Code:97489-9637
Practice Address - Country:US
Practice Address - Phone:541-896-3358
Practice Address - Fax:541-896-3358
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR091006794RN163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health