Healthcare Provider Details

I. General information

NPI: 1730792409
Provider Name (Legal Business Name): ASHLEY LISA THIESSEN NP, DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 06/07/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 3RD ST
TILLAMOOK OR
97141-3430
US

IV. Provider business mailing address

20700 SW KAWANDA CT
TUALATIN OR
97062-9598
US

V. Phone/Fax

Practice location:
  • Phone: 503-842-4444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201402956RN
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10015449
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: