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Individual

LISA BLAKLEY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
2222 NW LOVEJOY ST STE 422, PORTLAND, OR 97210-5102
(503) 227-7117
(503) 227-7120
Mailing address
541 NE 20TH AVE STE 225, PORTLAND, OR 97232-2895
(503) 963-2801

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA220196
OR

Other

Enumeration date
01/17/2024
Last updated
02/24/2025
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