Individual
LISSA DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1233 EDGEWATER ST NW, SALEM, OR 97304-4049
(503) 378-7526
(503) 480-1611
Mailing address
1233 EDGEWATER ST NW, SALEM, OR 97304-4049
(503) 378-7526
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
930605570
—
OR
Enumeration date
06/08/2022
Last updated
06/08/2022
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