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Individual

LISA A MESAROS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
931 S MARKET BLVD, PMG SW WA CHEHALIS FAMILY MEDICINE, CHEHALIS, WA 98532-3423
(360) 767-6300
Mailing address
PO BOX 3360, PMG SW WA, PORTLAND, OR 97208-3360
(866) 747-2455

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA60125666
WA
363AM0700X
Medical Physician Assistant
C0002085
MD

Other

Enumeration date
02/07/2008
Last updated
03/13/2014
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