Individual
LISA ANNE CRUPI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
707 SW GAINES ST, PORTLAND, OR 97239-2901
(503) 494-2062
Mailing address
707 SW GAINES ST, PORTLAND, OR 97239-2901
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
097007252N2
OR
363LP0200X
Pediatric Nurse Practitioner
097007252RN
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
227920
—
OR
Enumeration date
07/31/2006
Last updated
07/10/2007
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