Healthcare Provider Details

I. General information

NPI: 1811207913
Provider Name (Legal Business Name): LISA STEVENS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2010
Last Update Date: 08/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 HARTMAN LN
SPRINGFIELD OR
97477-1118
US

IV. Provider business mailing address

330 S GARDEN WAY STE 390
EUGENE OR
97401-8179
US

V. Phone/Fax

Practice location:
  • Phone: 541-334-3350
  • Fax: 541-284-5198
Mailing address:
  • Phone: 541-334-3350
  • Fax: 541-284-5198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA152783
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: