Healthcare Provider Details

I. General information

NPI: 1457118259
Provider Name (Legal Business Name): LISA RENEE ANGELESCO DNP, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2024
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

374 OWENS ST SE
SALEM OR
97302-4183
US

IV. Provider business mailing address

374 OWENS ST SE
SALEM OR
97302-4183
US

V. Phone/Fax

Practice location:
  • Phone: 503-972-0235
  • Fax:
Mailing address:
  • Phone: 503-972-0235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number201708869RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: