Healthcare Provider Details

I. General information

NPI: 1467619320
Provider Name (Legal Business Name): LISA M RADCLIFF F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15700 SW GREYSTONE CT
BEAVERTON OR
97006-6011
US

IV. Provider business mailing address

PO BOX 3378
PORTLAND OR
97208-3378
US

V. Phone/Fax

Practice location:
  • Phone: 503-203-1000
  • Fax: 503-203-1010
Mailing address:
  • Phone: 503-601-7636
  • Fax: 503-601-7622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200750073NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: