Healthcare Provider Details

I. General information

NPI: 1225085178
Provider Name (Legal Business Name): ELLEN J. LEMON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

266 W MAIN ST
HILLSBORO OR
97123-3961
US

IV. Provider business mailing address

PO BOX 568
CORNELIUS OR
97113-0568
US

V. Phone/Fax

Practice location:
  • Phone: 503-846-3360
  • Fax:
Mailing address:
  • Phone: 503-359-5564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberLL15941
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: