Individual
LANISHA DENISE FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
9701 SW BARNES RD STE LL60, PORTLAND, OR 97225-6772
(503) 297-8081
(503) 292-6601
Mailing address
541 NE 20TH AVE STE 225, PORTLAND, OR 97232-2895
(503) 963-2801
(503) 963-2825
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
MD222959
OR
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
ME159488
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2309172
—
WA
05
—
500848711
—
OR
Enumeration date
04/17/2018
Last updated
11/18/2025
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