Individual
LISA M INGOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1605 G ST, SPRINGFIELD, OR 97477-4227
(541) 747-6159
(541) 741-7249
Mailing address
1605 G ST, SPRINGFIELD, OR 97477-4227
(541) 747-6159
(541) 741-7249
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00654
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1538147053
—
OR
Enumeration date
01/04/2006
Last updated
07/21/2022
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