Individual
LIESEL ERNST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2924 SISKIYOU BLVD STE 200, MEDFORD, OR 97504-6462
(541) 200-2777
(541) 214-2575
Mailing address
2924 SISKIYOU BLVD STE 200, MEDFORD, OR 97504-6462
(541) 200-2777
(541) 214-2575
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1645
MN
363A00000X
Physician Assistant
55040
CA
363A00000X
Physician Assistant
Primary
PA184560
OR
Other
Enumeration date
12/22/2011
Last updated
03/09/2024
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