Individual
LISA MAE COWAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
19260 SW 65TH AVE STE 270, TUALATIN, OR 97062
(503) 885-9391
(503) 563-5520
Mailing address
19260 SW 65TH AVE, STE 270, TUALATIN, OR 97062-5705
(503) 885-9391
(503) 563-5520
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00679
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
215608
—
OR
01
—
R113018
MEDICARE PTAN
—
Enumeration date
11/02/2005
Last updated
08/15/2018
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