Individual
LISA BRAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
548 SE JACKSON ST, ROSEBURG, OR 97470-4983
(541) 672-2691
Mailing address
PO BOX 1121, ROSEBURG, OR 97470-0254
(541) 672-2691
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
163W00000X
Registered Nurse
Primary
201605428LPN
OR
164W00000X
Licensed Practical Nurse
PN5187199
FL
Other
Enumeration date
02/09/2018
Last updated
02/18/2021
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