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General NPI Number Information
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NPI Number | 1720028111
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Entity Type | Individual
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Provider Name | LISA PUMA PMHNP
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Gender | Female
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 03/21/2013
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Provider Practice Location Address
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Address Line | 610 SW ALDER ST SUITE 915
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City | PORTLAND
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State | OR
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Zip | 97205-3625
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Country | US
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Telephone | 503-830-1624
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Fax | 503-452-2872
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Provider Business Mailing Address
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Address Line | 8635 SW 52ND AVE
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City | PORTLAND
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State | OR
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Zip | 97219-3318
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Country | US
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Telephone | 503-452-9803
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Fax | 503-452-2872
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 087006211N6
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License Number State | OR
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