Healthcare Provider Details

I. General information

NPI: 1144376294
Provider Name (Legal Business Name): LESA L CAHILL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 S J ST
LAKEVIEW OR
97630-1680
US

IV. Provider business mailing address

620 S J ST
LAKEVIEW OR
97630-1680
US

V. Phone/Fax

Practice location:
  • Phone: 541-947-2331
  • Fax: 541-947-4854
Mailing address:
  • Phone: 541-947-2331
  • Fax: 541-947-4854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: