Individual
LISA ANNE HEREDIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
480 5TH ST STE 101, LAKE OSWEGO, OR 97034-3079
(503) 267-8041
Mailing address
480 5TH ST STE 101, LAKE OSWEGO, OR 97034-3079
(503) 267-8041
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
10055637
OR
Other
Enumeration date
01/16/2026
Last updated
01/18/2026
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