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General NPI Number Information
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NPI Number | 1154074680
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Entity Type | Individual
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Provider Name | LISA DIANE AMORUSO CNM
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Gender | Female
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Dates
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Enumeration Date | 02/03/2022
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 900 NE 139TH ST STE 206
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City | VANCOUVER
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State | WA
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Zip | 98685-2519
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Country | US
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Telephone | 360-487-1360
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Fax |
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Provider Business Mailing Address
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Address Line | 18109 NE 259TH ST
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City | BATTLE GROUND
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State | WA
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Zip | 98604-9712
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Country | US
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Telephone | 360-823-6961
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 202201206NP-PP
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | AP61264348
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License Number State | WA
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