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General NPI Number Information
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NPI Number | 1902042773
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Entity Type | Individual
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Provider Name | LISA MARIE ELLIS LAC
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Gender | Female
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Dates
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Enumeration Date | 12/29/2008
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Last Update Date | 12/29/2008
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Provider Practice Location Address
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Address Line | 1212 SE POWELL BLVD SUITE C
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City | PORTLAND
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State | OR
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Zip | 97202-2460
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Country | US
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Telephone | 541-556-3443
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Fax | 954-963-7169
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Provider Business Mailing Address
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Address Line | 1212 SE POWELL BLVD SUITE C
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City | PORTLAND
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State | OR
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Zip | 97202-2460
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Country | US
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Telephone | 541-556-3443
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Fax | 954-963-7169
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC00600
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License Number State | OR
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