=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316247760
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA MARGARET JONES PA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2010
-----------------------------------------------------
Last Update Date | 11/01/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 N COLUMBIA RIVER HWY SUITE 6
-----------------------------------------------------
City | SAINT HELENS
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97051-1299
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-397-0471
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 4399
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97208-4399
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-397-0471
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | PA152706
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------