MEDICARE: LISA NEVARA ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	AP30005552	WA
2	363LF0000X	Family Nurse Practitioner	097007189N1	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841376324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA NEVARA ARNP

Provider Business Mailing Address
First Line	:	425 E 7TH ST
Second Line	:
City	:	THE DALLES
State	:	OR
Zip	:	97058-2607
Country	:	US
Telephone Number	:	541-296-4610
Fax Number	:

Provider Business Practice Location Address
First Line	:	425 E. 7TH STREET
Second Line	:
City	:	THE DALLES
State	:	OR
Zip	:	97058-2607
Country	:	US
Telephone Number	:	541-296-4610
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	12/14/2011

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Directions to “ LISA NEVARA ARNP” Practice Location

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